Active NPI
Michael Hazboun, M.D.
- Pediatrics Physician
- Madera, CA
National Provider Identifier
1558755678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A148096
- Practice address
- 9300 Valley Childrens PL # FC06
Madera, CA 93636-8761 - Phone
- (559) 353-5803
- NPI assigned
- Mar 26, 2015
- Last updated
- Jul 28, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A148096 | CA | Primary |
Addresses
Primary practice location
9300 Valley Childrens PL # FC06
Madera, CA 93636-8761
Mailing address
9300 Valley Childrens PL # SC05
Madera, CA 93636-8761
Other practice location 1
3020 Childrens Way
MC 5124
San Diego, CA 92123-4223
Phone (858) 966-6764
Other practice location 2
3020 Childrens Way
San Diego, CA 92123
Phone (858) 966-8036
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A148096 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Specialty Medical Group Central California, Inc. | Pediatrics | Past | Accepting new patients |
| Valley Children's Medical Group | Pediatrics | Past | Accepting new patients |
| Rady Children's Hospital San Diego | Past | Accepting new patients | |
| Valley Children's Hospital | Past | Accepting new patients |
Interoperability endpoints
- mhazboun65326@valleychildrens-prd.direct-ci.com
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- San Diego, CA
- NPI 1851303994
-
- Pediatrics Physician
- Bakersfield, CA
- NPI 1326439977
-
- Children's Hospital
- Madera, CA
- NPI 1952312043
-
- Pediatrics Physician
- Modesto, CA
- NPI 1437555265
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658966400000",
"number": "1558755678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9300 VALLEY CHILDRENS PL # SC05",
"city": "MADERA",
"state": "CA",
"postal_code": "936368761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9300 VALLEY CHILDRENS PL # FC06",
"city": "MADERA",
"state": "CA",
"postal_code": "936368761",
"telephone_number": "559-353-5803"
}
],
"practiceLocations": [
{
"address_1": "3020 Childrens Way",
"address_2": "MC 5124",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921234223",
"country_code": "US",
"telephone_number": "858-966-6764",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3020 Childrens Way",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "92123",
"country_code": "US",
"telephone_number": "858-966-8036",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HAZBOUN",
"first_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-26",
"last_updated": "2022-07-28",
"certification_date": "2022-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A148096",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Madera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.