Provider Demographics
NPI:1053410506
Name:PEDIATRIC AFFILIATES MEDICAL GROUP INC
Entity type:Organization
Organization Name:PEDIATRIC AFFILIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-883-0460
Mailing Address - Street 1:7345 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1963
Mailing Address - Country:US
Mailing Address - Phone:818-883-0460
Mailing Address - Fax:818-883-2993
Practice Address - Street 1:7345 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1963
Practice Address - Country:US
Practice Address - Phone:818-883-0460
Practice Address - Fax:818-883-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty