Humboldt Pediatric Medical Corporation, INC.
Pediatrics in McKinleyville, CA. Organization (NPI-2).
NPI number1063927770
StatusActive
Last updated in NPPESDec 5, 2017
Details
- NPI
- 1063927770
- Entity type
- Organization (NPI-2)
- Legal business name
- Humboldt Pediatric Medical Corporation, INC.
- Organization subpart
- No
- Enumeration date
- Dec 5, 2017
- Last updated
- Dec 5, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | A64795 | CA | Yes |
Practice location
2192 Central Ave Ste AMcKinleyville, CA 95519-3610
Phone 707-839-1000 · Fax 707-839-1400
Mailing address
1011 Freshwater RdEureka, CA 95503-9457
Phone 707-599-0642
Authorized official
Sarah Bertram Poyen
MD
7075990642
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