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PEDIATRIC ADOLESCENT CLINIC
NPI 1164859385
Pediatrics - Adolescent Medicine in Upland, CA

Active since October 02, 2013
1214 ADRIANA WAY, UPLAND, CA 91784(909) 946-4155(909) 949-8836 Get Directions Write a Review

NPPES record last updated: October 2, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Pediatric Adolescent Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEDIATRIC ADOLESCENT CLINIC (NPI 1164859385) is a healthcare organization registered as an adolescent medicine in Upland, California and active in the NPI registry since October 2013. The organization lists Raouf Aziz Ibrahim, Pediatrician, as its authorized official.

NPPES Registry Identity

NPI1164859385
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NamePEDIATRIC ADOLESCENT CLINIC
Location Address1214 ADRIANA WAYUpland, CA 91784-1742
Mailing Address1214 Adriana WayUpland, CA 91784 · (909) 946-4155 · Fax (909) 949-8836
Phone(909) 946-4155
Fax(909) 949-8836
Organization SubpartNo
Authorized OfficialRaouf Aziz IbrahimPediatrician · (909) 946-4175
Enumeration DateOctober 2, 2013
✔ NPI 1164859385 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
License✔ Licensed in CA · AFE33327
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
1214 ADRIANA WAY, Upland, CA 91784
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pediatric Adolescent Clinic's NPI number?

The NPI number for Pediatric Adolescent Clinic is 1164859385. It was assigned to this organization in the NPPES registry on October 2, 2013.

Where is Pediatric Adolescent Clinic located?

Pediatric Adolescent Clinic is located at 1214 Adriana Way, Upland, CA 91784. The listed phone number is (909) 946-4155.

What is Pediatric Adolescent Clinic's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

When was this NPI record last updated?

The NPPES record for Pediatric Adolescent Clinic was last updated on October 2, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.