Healthcare Provider Details

I. General information

NPI: 1316565930
Provider Name (Legal Business Name): KIDSHEALTH PEDIATRICS, PLLC(SCOTTSDALE)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 E BELL RD STE 131
SCOTTSDALE AZ
85254-6010
US

IV. Provider business mailing address

5425 E BELL RD STE 131
SCOTTSDALE AZ
85254-6010
US

V. Phone/Fax

Practice location:
  • Phone: 602-374-3396
  • Fax: 602-374-3177
Mailing address:
  • Phone: 602-374-3396
  • Fax: 602-374-3177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA LOUELLA NABONG
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 602-374-3396