Healthcare Provider Details

I. General information

NPI: 1588935472
Provider Name (Legal Business Name): YUMA CHILDREN'S CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W 24TH ST
YUMA AZ
85364-6122
US

IV. Provider business mailing address

2150 W 24TH ST
YUMA AZ
85364-6122
US

V. Phone/Fax

Practice location:
  • Phone: 928-819-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SONAL M SUBBU
Title or Position: PHYSICIAN
Credential: MD
Phone: 928-819-7000