Provider Demographics
NPI:1881801835
Name:KIDS CARE PEDIATRICS MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:KIDS CARE PEDIATRICS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:VI
Authorized Official - Credentials:
Authorized Official - Phone:714-778-0623
Mailing Address - Street 1:1164 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1900
Mailing Address - Country:US
Mailing Address - Phone:714-778-0613
Mailing Address - Fax:
Practice Address - Street 1:1164 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1900
Practice Address - Country:US
Practice Address - Phone:714-778-0613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0527522080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0084522Medicare ID - Type UnspecifiedBILLING
CAGR0084521Medicare ID - Type UnspecifiedBILLING
CAGR0084520Medicare ID - Type UnspecifiedBILLING