Mindful Pediatric Gastroenterology, Inc

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

A106843 Issued in CA

Legal business name

MINDFUL PEDIATRIC GASTROENTEROLOGY, INC

Practice address

65 N Madison Ave
Suite 709
Pasadena, CA 91101-2035

Phone

(626) 800-4059

Fax

(626) 800-3974

NPI assigned

Sep 5, 2014

Last updated

Sep 9, 2014By 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

Dr. Gilberto Bultron, M.D.

Title

Ceo

Phone

(626) 800-4059

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Smita Malhotra, M.D.

  • Pediatrics Physician
  • Fontana, CA
  • NPI 1649437310
  NPD (past)

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

{
    "created_epoch": "1409875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410220800000",
    "number": "1790186112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 N MADISON AVE",
            "address_2": "SUITE 709",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012035",
            "telephone_number": "626-800-4059",
            "fax_number": "626-800-3974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 N MADISON AVE",
            "address_2": "SUITE 709",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012035",
            "telephone_number": "626-800-4059",
            "fax_number": "626-800-3974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL PEDIATRIC GASTROENTEROLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-05",
        "last_updated": "2014-09-09",
        "status": "A",
        "authorized_official_last_name": "BULTRON",
        "authorized_official_first_name": "GILBERTO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "626-800-4059",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "CA",
            "license": "A106843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Gastroenterology Physician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Pediatric Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2014; 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.