NPI 1114048154 · live from the CMS NPI Registry
Affton Medical Clinic
Pediatrics, Adolescent Medicine in Saint Louis, MO. National Provider Identifier 1114048154, active.
NPI record
| NPI | 1114048154 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pediatrics, Adolescent Medicine 2080A0000X |
| Practice location | 59 Grasso Plz, Saint Louis, MO 63123 |
| Practice phone | 314-638-9309 |
| Enumerated | April 3, 2007 |
| Last updated | June 16, 2008 |
| Authorized official | Rubilinda Casino, Medical Director |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatrics, Adolescent Medicine primary | 2080A0000X | R5P40 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.