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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

NPI Number 1164859385
LBN Legal business name PEDIATRIC ADOLESCENT CLINIC
Authorized official RAOUF IBRAHIM - (PEDIATRICIAN)
Entity Organization
Organization subpart 1 No
Enumeration date 10/02/2013
Last updated 10/02/2013 - About 13 years ago
Identifiers
CA License # AFE33327
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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