Provider Demographics
NPI:1629372156
Name:HAVEN PEDIATRICS AND ADOLESCENT CARE INC
Entity type:Organization
Organization Name:HAVEN PEDIATRICS AND ADOLESCENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-941-9955
Mailing Address - Street 1:10837 LAUREL ST
Mailing Address - Street 2:STE 104
Mailing Address - City:RANCHO CUCOMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-941-9955
Mailing Address - Fax:909-941-9966
Practice Address - Street 1:10837 LAUREL ST
Practice Address - Street 2:STE 104
Practice Address - City:RANCHO CUCOMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-941-9955
Practice Address - Fax:909-941-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92596208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty