Organization
HUMBOLDT PEDIATRIC MEDICAL CORPORATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SARAH BERTRAM POYEN MD (MD)
(707) 599-0642
Entity
Organization
Contact information
Practice address
2192 CENTRAL AVE STE A, MCKINLEYVILLE, CA 95519-3610
(707) 839-1000
(707) 839-1400
Mailing address
1011 FRESHWATER RD, EUREKA, CA 95503-9457
(707) 599-0642
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A64795
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548234693
—
CA
05
—
1629074570
—
CA
Enumeration date
12/05/2017
Last updated
12/05/2017
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