Healthcare Provider Details

I. General information

NPI: 1457697104
Provider Name (Legal Business Name): KIDS KARE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
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: 602-845-3192
  • Fax: 602-252-2644
Mailing address:
  • Phone: 602-845-3192
  • Fax: 602-252-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARLOS LOPEZ
Title or Position: OWNER
Credential: MD
Phone: 602-845-3192