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General NPI Number Information
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NPI Number | 1356512818
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Entity Type | Organization
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Legal Business Name | KIDS CONNECTION PEDIATRICS
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 3811 E BELL RD. SUITE 110
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City | PHOENIX
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State | AZ
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Zip | 85032
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Country | US
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Telephone | 602-404-2020
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Fax | 602-404-2268
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Provider Business Mailing Address
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Address Line | 3811 E. BELL RD. SUITE 110
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City | PHOENIX
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State | AZ
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Zip | 85032
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Country | US
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Telephone | 602-404-2020
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Fax | 602-404-2268
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KARA TIFFANY
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Credential | MD
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Telephone | 602-404-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 26155
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License Number State | AZ
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