Pediatric Adolescent Clinic

Organization Pediatric Adolescent Medicine Physician · NPI 1164859385

Pediatric Adolescent Clinic is a Pediatric Adolescent Medicine Physician in Upland, California. Licensed in California. Registered with an NPI since 2013.

Licensed in: CA
In the registry since: 2013

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Practice location Address checks out

1214 Adriana Way
Upland, CA 91784-1742
Phone: (909) 946-4155
Fax: (909) 949-8836

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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Adolescent Medicine Physician (primary)	Taxonomy 2080A0000X · Licence AFE33327 (CA)

Record details

NPI number	1164859385
Entity type	Organization (Type 2)
Organization subpart	No
Authorized official	Raouf Ibrahim — Pediatrician · (909) 946-4175
NPI enumerated	October 2, 2013
Last updated in NPPES	October 2, 2013
Mailing address	1214 Adriana Way, Upland, CA 91784