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 3 days ago.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