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General NPI Number Information
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NPI Number | 1265464424
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Entity Type | Organization
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Legal Business Name | JAVELINA PEDIATRICS PLLC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 1521 E TANGERINE RD SUITE 205
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City | ORO VALLEY
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State | AZ
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Zip | 85755-6225
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Country | US
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Telephone | 520-531-0060
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Fax | 520-225-0156
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Provider Business Mailing Address
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Address Line | 1521 E TANGERINE RD SUITE 205
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City | ORO VALLEY
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State | AZ
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Zip | 85755-6225
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Country | US
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Telephone | 520-531-0060
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Fax | 520-225-0156
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP S TRAQUAIR
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Credential | MD
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Telephone | 520-531-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 33911
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License Number State | AZ
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