Pediatric Psychiatric Med Assoc Cho

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

G77771 Issued in CA

Legal business name

PEDIATRIC PSYCHIATRIC MED ASSOC CHO

Practice address

747 52ND St
Oakland, CA 94609-1809

Phone

(510) 428-3571

Fax

(510) 597-7171

NPI assigned

Feb 27, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa Hardy, MD

Title

Head of Dept

Phone

(510) 428-3571

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Childrens Hospital and Research Center at Oakland2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Childrens Hospital and Research Center at Oakland

  • Children's Hospital
  • Oakland, CA
  • NPI 1831128974
  NPD tax ID

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1568599421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3116 W MARCH LN",
            "address_2": "STE 200",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952192369",
            "telephone_number": "209-473-6555",
            "fax_number": "209-473-6543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 52ND ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946091809",
            "telephone_number": "510-428-3571",
            "fax_number": "510-597-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PSYCHIATRIC MED ASSOC CHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARDY",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "HEAD OF DEPT",
        "authorized_official_telephone_number": "510-428-3571",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "CA",
            "license": "G77771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL #",
            "identifier": "GR0095840",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR HARDY'S CA MD LIC",
            "identifier": "G77771",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Aline Pedelaborde
• Rachel Therese Pedemonte, FNP, RN
• Pediatric Contracting Services, Inc.
• Pediatric Hematology Oncology
• Pediatric Imaging Medical Associates
• Pediatric Rehab Med Assoc
• Pediatric Surgical Associates of the East Bay
• Annie Rose Pedlar, FNP, DNP
• Andrea Pedraza
• Donna Reimann Pedroza, LCSW

• Developmental - Behavioral Pediatrics Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• Developmental - Behavioral Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.