Healthcare Provider Details

I. General information

NPI: 1710318019
Provider Name (Legal Business Name): HEALTHY KIDZ PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S POWER RD SUITE # 106
MESA AZ
85206-5235
US

IV. Provider business mailing address

215 S POWER RD SUITE # 106
MESA AZ
85206-5235
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-0051
  • Fax: 480-214-0055
Mailing address:
  • Phone: 480-214-0051
  • Fax: 480-214-0055

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. RAMON MEZA CARRASCO
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 602-628-8064