Central California Pediatric Specialty Medical Group Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A69635 Issued in CA

Legal business name

CENTRAL CALIFORNIA PEDIATRIC SPECIALTY MEDICAL GROUP INC

Practice address

400 W Mineral King Ave
Visalia, CA 93291-6237

Phone

(559) 280-9165

Fax

(559) 635-2696

NPI assigned

Jul 28, 2011

Last updated

Jan 26, 2017By 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. Ana Carolina Coll, M.D

Title

Cfo

Phone

(559) 280-9165

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1311811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485388800000",
    "number": "1871871624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5940 W BUENA VISTA CT",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932919173",
            "telephone_number": "559-280-9165",
            "fax_number": "559-635-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W MINERAL KING AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916237",
            "telephone_number": "559-280-9165",
            "fax_number": "559-635-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CALIFORNIA PEDIATRIC SPECIALTY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-28",
        "last_updated": "2017-01-26",
        "status": "A",
        "authorized_official_last_name": "COLL",
        "authorized_official_first_name": "ANA CAROLINA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "559-280-9165",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A69432",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A69635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Visalia, CA
• Providers in Visalia, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; 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.