Healthcare Provider Details

I. General information

NPI: 1063603785
Provider Name (Legal Business Name): HAPPY KIDS PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 E MAIN ST SUITE 103
MESA AZ
85203-8947
US

IV. Provider business mailing address

4802 E RAY RD STE 23 PMB 274
PHOENIX AZ
85044-6410
US

V. Phone/Fax

Practice location:
  • Phone: 480-223-0291
  • Fax: 480-223-0295
Mailing address:
  • Phone: 480-223-0291
  • Fax: 480-223-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24255
License Number StateAZ

VIII. Authorized Official

Name: DR. JOSE FRANCISCO CARRAZCO
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 480-223-0091