# MERCY ASSOCIATED PEDIATRICS SUBSPECIALISTS MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558483172
- **Authorized official:** DR. RIAD MARDOUM M.D. (CEO)
- **Authorized official phone:** (619) 260-7046

## Contact information

- **Practice address:** 4077 5TH AVE, SAN DIEGO, CA 92103-2105
- **Practice address phone:** (619) 260-7046
- **Mailing address:** PO BOX 33855, SAN DIEGO, CA 92163-3855
- **Mailing address phone:** (619) 401-4016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | NULL | Yes |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/04/2007
- **Last updated:** 08/22/2020