| Organization Name: | PEDIATRIC HEALTH AND WELLNESS |
| NPI Number: | 1124426580 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUNNIE S SKILES (OWNER) |
| Mailing Address: | 6815 Five Star Blvd Suite 100 Rocklin |
| State: | CA US |
| Postal Code: | 956772688 |
| Phone Number: | 9166263060 |
| Fax Number: | 9166263063 |
| NPI Enumeration Date: | 12/16/2014 |
| NPI Last Update Date: | 12/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | G66133 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |