Organization
PEDIATRIC GASTROENTEROLOGY OF MONTEREY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDERS KARL DAHLSTROM M.D. PH.D. (PRESIDENT (OF CORPORATION)/CEO)
(831) 626-3259
Entity
Organization
Contact information
Practice address
1900 GARDEN ROAD SUITE 110, PEDIATRIC GROUP OF MONTEREY, MONTEREY, CA 93940
(831) 626-3259
(888) 860-1110
Mailing address
PO BOX 204, PEBBLE BEACH, CA 93953
(831) 626-3259
(888) 860-1110
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
A52400
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A52400
CALIFORNIA STATE LICENCE
CA
Enumeration date
01/19/2010
Last updated
03/18/2010
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