Healthcare Provider Details

I. General information

NPI: 1982243507
Provider Name (Legal Business Name): KIDS HEALTH FIRST PEDIATRICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79440 CORPORATE CENTER DR STE 108
LA QUINTA CA
92253-7243
US

IV. Provider business mailing address

79440 CORPORATE CENTER DR STE 108
LA QUINTA CA
92253-7243
US

V. Phone/Fax

Practice location:
  • Phone: 750-564-0902
  • Fax: 760-406-6039
Mailing address:
  • Phone: 750-564-0902
  • Fax: 760-406-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICIA CRUZ REYES
Title or Position: MD
Credential: MD
Phone: 760-564-0902