Healthcare Provider Details

I. General information

NPI: 1639619968
Provider Name (Legal Business Name): PEDIATRICS KARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 W THOMAS RD #CO64
PHOENIX AZ
85033-5469
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 602-242-5005
  • Fax: 888-846-8757
Mailing address:
  • Phone: 602-252-1439
  • Fax: 888-846-8757

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 J LOPEZ
Title or Position: OWNER
Credential: MD
Phone: 602-252-1439