Healthcare Provider Details

I. General information

NPI: 1649380205
Provider Name (Legal Business Name): WEST PHOENIX PEDIATRICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD SUITE 450
PHOENIX AZ
85037
US

IV. Provider business mailing address

9305 W THOMAS RD SUITE 450
PHOENIX AZ
85037
US

V. Phone/Fax

Practice location:
  • Phone: 623-889-6186
  • Fax: 623-889-6188
Mailing address:
  • Phone: 623-889-6186
  • Fax: 623-889-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34213
License Number StateAZ

VIII. Authorized Official

Name: CELIDA RANGEL
Title or Position: MEMBER
Credential: MD
Phone: 623-889-6186