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Organization
THE PEDIATRIC SPECIALISTS MEDICAL GROUP, INC.
Active
Organization
THE PEDIATRIC SPECIALISTS MEDICAL GROUP, INC.
Active
Other names
Pediatric Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN H. HOFFMAN M.D. (OWNER)
(805) 481-3166
Entity
Organization
Contact information
Practice address
138 W BRANCH ST, SUITE A, ARROYO GRANDE, CA 93420-2611
(805) 481-3166
(805) 481-8237
Mailing address
138 W BRANCH ST, SUITE A, ARROYO GRANDE, CA 93420-2611
(805) 481-3166
(805) 481-8237
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
55326
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0105730
—
CA
01
—
ZZZ50949Y
BLUE SHIELD
CA
Enumeration date
11/01/2006
Last updated
02/28/2008
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