NPIMap

Organization Active NPI

Pediatric Partners Medical Professional Corporation

  • Pediatric Adolescent Medicine Physician
  • Ridgecrest, CA
National Provider Identifier
1356656664
Registry record updated Aug 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
0900009973 Issued in CA
Legal business name
PEDIATRIC PARTNERS MEDICAL PROFESSIONAL CORPORATION
Practice address
1111 N China Lake Blvd
Suite 120
Ridgecrest, CA 93555-3131
Phone
(760) 446-7337
Fax
(760) 446-7338
NPI assigned
Aug 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2010

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

Authorized official

Name
Cheryl Fuchigami-Bost, RN, RN
Title
Chief Operations Officer
Phone
(951) 252-8588

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X 0900009973 CA Primary

Addresses

Primary practice location

1111 N China Lake Blvd
Suite 120
Ridgecrest, CA 93555-3131

Mailing address

27699 Jefferson Ave
Suite 300
Temecula, CA 92590-2661
Phone (951) 252-8588

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Partners Medical Professional Corporation12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1111 N China Lake Blvd
Ste 120
Ridgecrest, CA 93555
Phone (760) 446-7337

27699 Jefferson Ave
Ste 300
Temecula, CA 92590
Phone (951) 252-8588

NPI Registry JSON

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281484800000",
    "number": "1356656664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27699 JEFFERSON AVE",
            "address_2": "SUITE 300",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925902661",
            "telephone_number": "951-252-8588",
            "fax_number": "951-252-8589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 N CHINA LAKE BLVD",
            "address_2": "SUITE 120",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935553131",
            "telephone_number": "760-446-7337",
            "fax_number": "760-446-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PARTNERS MEDICAL PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-11",
        "last_updated": "2010-08-11",
        "status": "A",
        "authorized_official_last_name": "FUCHIGAMI-BOST, RN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "951-252-8588",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "0900009973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgecrest, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; 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.