Healthcare Provider Details

I. General information

NPI: 1083805030
Provider Name (Legal Business Name): HAPPY KIDS PEDIATRICS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 E MAIN ST STE 103
MESA AZ
85203-8950
US

IV. Provider business mailing address

2033 E WARNER RD STE 109
TEMPE AZ
85284-3417
US

V. Phone/Fax

Practice location:
  • Phone: 480-223-0290
  • Fax:
Mailing address:
  • Phone: 480-820-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSE CARRAZCO
Title or Position: OWNER
Credential: MD
Phone: 480-820-5525