Healthcare Provider Details

I. General information

NPI: 1083815666
Provider Name (Legal Business Name): NORTHWEST CLOINIC FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15420 N 32ND DR
PHOENIX AZ
85053-3927
US

IV. Provider business mailing address

15420 N 32ND DR
PHOENIX AZ
85053-3927
US

V. Phone/Fax

Practice location:
  • Phone: 602-866-1974
  • Fax: 602-789-9202
Mailing address:
  • Phone: 602-866-1974
  • Fax: 602-789-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERI CAIAFA
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-866-1974