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Contact Information

PEDIATRIC ADOLESCENT CLINIC
1214 ADRIANA WAY
UPLAND, CA91784-1742
 Phone: 909-946-4155
 Fax: 909-949-8836
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Adolescent Medicine

2080A0000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for PEDIATRIC ADOLESCENT CLINIC · (Female)

NPI Number 1164859385
Status Active
Credentials
Entity Individual
Enumeration date 10/02/2013
Last updated 10/02/2013 - About 13 years ago
Sole proprietor 1 Not specified
Identifiers
  • CA License # AFE33327
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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