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Organization
PEDIATRIC MEDICAL GROUP OF SANTA MARIA INC
Active
Organization
PEDIATRIC MEDICAL GROUP OF SANTA MARIA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE D ROSTERMUNDT DO (PHYSICIAN MANAGER)
(805) 922-3548
Entity
Organization
Contact information
Practice address
1430 E MAIN ST, #201, SANTA MARIA, CA 93454
(805) 922-3548
(805) 928-5609
Mailing address
1430 E MAIN ST, #201, SANTA MARIA, CA 93454
(805) 922-3548
(805) 928-5609
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
YYY48371Y
—
CA
Enumeration date
09/11/2006
Last updated
03/03/2011
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