Healthcare Provider Details

I. General information

NPI: 1558284422
Provider Name (Legal Business Name): 3GPKIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W CAMELBACK RD STE A
PHOENIX AZ
85013
US

IV. Provider business mailing address

24 W CAMELBACK RD STE A
PHOENIX AZ
85013-2529
US

V. Phone/Fax

Practice location:
  • Phone: 623-377-2747
  • Fax:
Mailing address:
  • Phone: 623-377-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLOS RIVERA
Title or Position: PROVIDER
Credential: APRN
Phone: 623-377-2747