| NPI | 1730613431 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP - PEDIATRICS |
| Entity Type | Organization |
| Authorized Contact | YESICA VIEYRA Credentialing Specialist 205-939-7633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2019-02-15 |