NPI 1063255024 · live from the CMS NPI Registry
Bridge Centers LLC
Pediatrics, Developmental - Behavioral Pediatrics in Eagan, MN. National Provider Identifier 1063255024, active.
NPI record
| NPI | 1063255024 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pediatrics, Developmental - Behavioral Pediatrics 2080P0006X |
| Practice location | 4310 N Woodgate Ln, Eagan, MN 55122 |
| Practice phone | 952-492-1031 |
| Enumerated | June 17, 2024 |
| Last updated | June 17, 2024 |
| Authorized official | Abdifatah Mohamed, Director |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatrics, Developmental - Behavioral Pediatrics primary | 2080P0006X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.