Provider Demographics
NPI:1770739989
Name:NATIVITY PEDIATRICS, INC
Entity type:Organization
Organization Name:NATIVITY PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EULE
Authorized Official - Middle Name:NAGRAMPA
Authorized Official - Last Name:BIYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-817-6461
Mailing Address - Street 1:740 OAK AVENUE PKWY STE 145
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6815
Mailing Address - Country:US
Mailing Address - Phone:916-817-6461
Mailing Address - Fax:916-358-5297
Practice Address - Street 1:740 OAK AVENUE PKWY STE 145
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6815
Practice Address - Country:US
Practice Address - Phone:916-817-6461
Practice Address - Fax:916-358-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0900010314261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851408090OtherINDIVIDUAL NPI