Provider Demographics
NPI:1750181236
Name:SOUTH PASADENA PEDIATRICS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SOUTH PASADENA PEDIATRICS, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILDERSLEEVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-514-0315
Mailing Address - Street 1:1941 HUNTINGTON DR STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4994
Mailing Address - Country:US
Mailing Address - Phone:626-514-0315
Mailing Address - Fax:
Practice Address - Street 1:1941 HUNTINGTON DR STE C
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4994
Practice Address - Country:US
Practice Address - Phone:626-514-0315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty