Pacific Coast Pediatric Center Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PACIFIC COAST PEDIATRIC CENTER INC

Practice address

252 Green Valley Rd
Freedom, CA 95019-3138

Phone

(831) 722-0272

Fax

(831) 722-1007

NPI assigned

Dec 31, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Linda Lee Shaw, MD

Title

Owner, Partner, Secy-Treas

Phone

(831) 722-0272

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199145600000",
    "number": "1619152402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "252 GREEN VALLEY RD",
            "city": "FREEDOM",
            "state": "CA",
            "postal_code": "950193138",
            "telephone_number": "831-722-0272",
            "fax_number": "831-722-1007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "252 GREEN VALLEY RD",
            "city": "FREEDOM",
            "state": "CA",
            "postal_code": "950193138",
            "telephone_number": "831-722-0272",
            "fax_number": "831-722-1007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC COAST PEDIATRIC CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-31",
        "last_updated": "2008-01-01",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER, PARTNER, SECY-TREAS",
        "authorized_official_telephone_number": "831-722-0272",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FICTITIOUS NAME PERMIT CA",
            "identifier": "36791",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Freedom, CA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2008; 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.