OrganizationChildren'S Specialists Of San Diego - Div Of Ent(Children'S Associated Medical Group)OtolaryngologyAllopathic & Osteopathic PhysiciansPractice Address3030 Childrens Way, Suite 402, San Diego, CA 92123-4232(858) 309-7701(858) 309-6303PECOS EnrollmentBased on the most recent information from CMS, provider Children'S Specialists Of San Diego - Div Of Ent does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 4:18 PM.Profile DetailsProvider ID1407913973Provider TypeOrganizationFull NameChildren'S Specialists Of San Diego - Div Of EntOther NameChildren'S Associated Medical GroupSubpartYesEnumeration Date1/3/2007Last Updated4/22/2008Contact InformationPractice LocationPractice Address3030 Childrens Way, Suite 402, San Diego, CA 92123-4232Phone(858) 309-7701FaxUnlisted FaxMailing LocationMailing Address3860 Calle Fortunada, Suite 210, San Diego, CA 92123-4800Phone(858) 309-6303Fax(858) 309-6301Authorized OfficialNameKimmons, Herbert C. (President)Phone(858) 966-8567Provider TaxonomiesCodeDescriptionLicenseCode207YP0228XPrimaryDescriptionOtolaryngologyAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode207Y00000XDescriptionOtolaryngologyAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDGR006886FDescriptionMedicaidIssuerUnlistedCalifornia