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SAN PEDRO PEDIATRICS MED GRP INC
NPI 1255446142
Pediatrics in San Pedro, CA

Active since August 20, 2006CLIA 05D0666609 · Waiver
1294 W 6TH ST, STE #102, SAN PEDRO, CA 90731(310) 832-6487(310) 832-6913 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About San Pedro Pediatrics Med Grp Inc NPPES

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

SAN PEDRO PEDIATRICS MED GRP INC (NPI 1255446142) is a healthcare organization registered as a pediatrics in San Pedro, California and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through July 30, 2027 and lists Frank Brow, President, as its authorized official.

NPPES Registry Identity

NPI1255446142
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameSAN PEDRO PEDIATRICS MED GRP INC
Location Address1294 W 6TH ST, STE #102San Pedro, CA 90731-2987
Mailing Address1294 W 6th St, Ste #102San Pedro, CA 90731-2987 · (310) 832-6487 · Fax (310) 832-6913
Phone(310) 832-6487
Fax(310) 832-6913
Organization SubpartNo
Authorized OfficialFrank BrowPresident · (310) 832-6487
Enumeration DateAugust 20, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1255446142 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
1294 W 6TH ST, San Pedro, CA 90731
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Other Identifiers 1

MedicaidZZZ43733ZCA

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0666609

San Pedro Pediatric Medical Group Inc · San Pedro, CA
Active · expires Jul 30, 2027
CLIA Number05D0666609
Laboratory TypePhysician Office
Certificate Effective DateJuly 31, 2025
Certificate Expiration DateJuly 30, 2027
Laboratory DirectorGrace C. Petterson MD
Laboratory Phone(310) 832-0616
Laboratory LocationSan Pedro Pediatric Medical Group Inc1294 West 6th Street Ste 102, San Pedro, CA 90731
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BORROWED STAR PSYCHOLOGY GROUP, INC
Psychologist (Clinical)
1294 W 6TH ST, SUITE 105
SAN PEDRO, CA 90731
Los Angeles County (310) 902-6089
DR. GRACE C. PETTERSON MD
Specialist
1294 W 6TH ST, STE#102
SAN PEDRO, CA 90731
Los Angeles County (310) 832-6487
KIMBERLY R WALTON MD INC
Obstetrics & Gynecology (Obstetrics)
1294 W 6TH ST, 201-A
SAN PEDRO, CA 90731
Los Angeles County (310) 831-6515
MICHAEL T O'DONNELL DPT, OCS
Physical Therapist
1294 W 6TH ST, SUITE 101
SAN PEDRO, CA 90731
Los Angeles County (310) 547-1850
MICHAEL CULMER M.D.
Pediatrics
1294 W 6TH ST, SUITE 104
SAN PEDRO, CA 90731
Los Angeles County (321) 054-8911
DR. ANDREW P NOVOM MD
Specialist
1294 W 6TH ST, STE#102
SAN PEDRO, CA 90731
Los Angeles County (310) 832-6487
GENESA WAGONER M.D.
Pediatrics
1294 W 6TH ST, SUITE 104
SAN PEDRO, CA 90731
Los Angeles County (310) 548-9118
DR. PRISCILLA S NOVOM MD
Specialist
1294 W 6TH ST, STE#102
SAN PEDRO, CA 90731
Los Angeles County (310) 832-6487

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 San Pedro Pediatrics Med Grp Inc's NPI number?

The NPI number for San Pedro Pediatrics Med Grp Inc is 1255446142. It was assigned to this organization in the NPPES registry on August 20, 2006.

Where is San Pedro Pediatrics Med Grp Inc located?

San Pedro Pediatrics Med Grp Inc is located at 1294 W 6th St Ste #102, San Pedro, CA 90731. The listed phone number is (310) 832-6487.

What is San Pedro Pediatrics Med Grp Inc's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does San Pedro Pediatrics Med Grp Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0666609) is associated with this NPI, valid through July 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for San Pedro Pediatrics Med Grp Inc was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.