Healthcare Provider Details

I. General information

NPI: 1508406075
Provider Name (Legal Business Name): KIDS AND FAMILY KARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W THOMAS RD FL 2
PHOENIX AZ
85013-4241
US

IV. Provider business mailing address

521 W THOMAS RD FL 2
PHOENIX AZ
85013-4241
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-0390
  • Fax: 480-591-8950
Mailing address:
  • Phone: 602-254-0390
  • Fax: 888-846-8757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS J LOPEZ
Title or Position: OWNER/MANAGER
Credential: MD
Phone: 602-254-0390