Organization
CHILDRENS MEDICAL GROUP OF SOUTH BAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELAINE HELENA COHEN MD (VICE PRESIDENT)
(619) 425-3951
Entity
Organization
Contact information
Practice address
280 E STREET, CHULA VISTA, CA 91910
(619) 425-3951
Mailing address
280 E STREET, CHULA VISTA, CA 91910
(619) 425-3951
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0004830
—
CA
Enumeration date
01/25/2007
Last updated
08/22/2020
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