Healthcare Provider Details

I. General information

NPI: 1508300013
Provider Name (Legal Business Name): PEDIATRICS & FAMILY KARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13229 N 41ST PL
PHOENIX AZ
85032-6709
US

IV. Provider business mailing address

13229 N 41ST PL
PHOENIX AZ
85032-6709
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-0390
  • Fax: 602-513-8691
Mailing address:
  • Phone: 602-254-0390
  • Fax: 602-513-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27821
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33381
License Number StateAZ

VIII. Authorized Official

Name: LUZ A LOPEZ
Title or Position: DOCTOR
Credential: MD
Phone: 602-254-0390