Provider Demographics
NPI:1144468620
Name:PEDIATRIC SUBSPECIALTY FACULTY, INC.
Entity type:Organization
Organization Name:PEDIATRIC SUBSPECIALTY FACULTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HALE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-289-4511
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:PSF NEONATOLOGY
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3835
Mailing Address - Country:US
Mailing Address - Phone:714-532-8620
Mailing Address - Fax:714-289-4072
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:PSF NEONATOLOGY
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3835
Practice Address - Country:US
Practice Address - Phone:714-532-8620
Practice Address - Fax:714-289-4072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC SUBSPECIALTY FACULTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093905051Medicaid
CA1093905051Medicaid