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General NPI Number Information
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NPI Number | 1386833119
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Entity Type | Organization
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Legal Business Name | PRAISE PEDIATRICS LLC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 84 ACOMA BLVD N SUITE 104
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6096
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Country | US
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Telephone | 928-855-0520
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Fax | 928-855-0537
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Provider Business Mailing Address
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Address Line | PO BOX 3502
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86405-3502
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Country | US
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Telephone | 928-855-0520
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Fax | 928-855-0537
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Authorized Official
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Title or Position | OWNER
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Name | DR. MONETTE PIERRE-LOUIS
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Credential | M.D.
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Telephone | 928-855-0520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 37592
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License Number State | AZ
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