Organization
PEDIATRIC REHAB MED ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT HAINING MD (HEAD OF DEPT)
(510) 428-3655
Entity
Organization
Contact information
Practice address
747 52ND ST, OAKLAND, CA 94609-1809
(510) 428-3655
(510) 450-5821
Mailing address
3116 W MARCH LN, STE 200, STOCKTON, CA 95219-2369
(209) 473-6555
(209) 473-6543
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
A38652
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A38652
DR HAINING'S CA MD LIC
CA
01
—
GR0095340
MEDI-CAL #
CA
Enumeration date
02/27/2007
Last updated
08/22/2020
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