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General NPI Number Information
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NPI Number | 1043074610
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Entity Type | Organization
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Legal Business Name | GLENDALE PEDIATRICS LLC
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 2929 N 75TH AVE STE 5&6
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City | PHOENIX
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State | AZ
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Zip | 85033-5400
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Country | US
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Telephone | 623-873-1200
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Fax | 623-847-5304
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Provider Business Mailing Address
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Address Line | 6745 N 51ST DR
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City | GLENDALE
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State | AZ
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Zip | 85301-3425
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Country | US
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Telephone | 623-847-5300
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ENRIQUE SION LOPEZ
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Credential |
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Telephone | 623-847-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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