Organization
TRI-VALLEY NEONATAL MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARA NORDBERG (ACCOUNTS ADMINISTRATOR)
(949) 492-3514
Entity
Organization
Contact information
Practice address
15107 VANOWEN ST, VAN NUYS, CA 91405-4542
(818) 902-2978
Mailing address
PO BOX 1359, SAN CLEMENTE, CA 92674-1359
(949) 492-3514
(949) 366-2390
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0097480
—
CA
Enumeration date
09/28/2006
Last updated
02/08/2010
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