Provider Demographics
NPI:1912087057
Name:PEDIATRIC CARE PHYSICIANS A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PEDIATRIC CARE PHYSICIANS A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPRATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-461-9690
Mailing Address - Street 1:5353 BALBOA BLVD
Mailing Address - Street 2:#200
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2804
Mailing Address - Country:US
Mailing Address - Phone:818-461-9690
Mailing Address - Fax:818-461-9482
Practice Address - Street 1:5353 BALBOA BLVD
Practice Address - Street 2:#200
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2804
Practice Address - Country:US
Practice Address - Phone:818-461-9690
Practice Address - Fax:818-461-9482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG068087208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty