Provider Demographics
NPI:1487980728
Name:MPG PEDIATRICS, P.C.
Entity type:Organization
Organization Name:MPG PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:BANAL
Authorized Official - Last Name:BLANCAFLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:671-648-5437
Mailing Address - Street 1:396 CHALAN SAN ANTONIO
Mailing Address - Street 2:BRI BUILDING SUITE 103
Mailing Address - City:TAMVNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-648-5437
Mailing Address - Fax:671-649-5437
Practice Address - Street 1:396 CHALAN SAN ANTONIO
Practice Address - Street 2:BRI BUILDING SUITE 103
Practice Address - City:TAMVNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-648-5437
Practice Address - Fax:671-649-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-001283208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty