NPIMap

Organization Active NPI

San Diego Pediatric Neurology, Inc.

  • Neurology Physician
  • San Diego, CA
National Provider Identifier
1306433032
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
SAN DIEGO PEDIATRIC NEUROLOGY, INC.
Practice address
3003 Health Center Dr
San Diego, CA 92123-2700
Phone
(858) 939-4185
Fax
(858) 939-4972
NPI assigned
Dec 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Michaela Cavanaugh
Title
Practice Administrator
Phone
(858) 598-5472

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

3003 Health Center Dr
San Diego, CA 92123-2700

Mailing address

8555 Aero Dr Ste 340
San Diego, CA 92123-1740
Phone (858) 384-7828

National Provider Directory

National Provider Directory

Locations

8555 Aero Dr
Ste 340
San Diego, CA 92123

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1306433032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8555 AERO DR STE 340",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231740",
            "telephone_number": "858-384-7828",
            "fax_number": "858-598-6344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 HEALTH CENTER DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232700",
            "telephone_number": "858-939-4185",
            "fax_number": "858-939-4972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO PEDIATRIC NEUROLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-29",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A",
        "authorized_official_last_name": "CAVANAUGH",
        "authorized_official_first_name": "MICHAELA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "858-598-5472",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.