Healthcare Provider Details

I. General information

NPI: 1558371526
Provider Name (Legal Business Name): WOMAN AND CHILD HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 MESQUITE AVE SUITE 210
LAKE HAVASU CITY AZ
86403-5677
US

IV. Provider business mailing address

1851 MESQUITE AVE SUITE 210
LAKE HAVASU CITY AZ
86403-5677
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-8100
  • Fax: 928-854-8182
Mailing address:
  • Phone: 928-854-8100
  • Fax: 928-854-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberAZ32330
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAZ4026
License Number StateAZ

VIII. Authorized Official

Name: DR. DEREK D KAZNOSKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 928-854-8100