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General NPI Number Information
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NPI Number | 1396024576
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Entity Type | Organization
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Legal Business Name | YOUNG ARIZONA PEDIATRICS LLC
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 15653 N REEMS RD STE 110
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City | SURPRISE
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State | AZ
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Zip | 85374-9541
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Country | US
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Telephone | 623-214-3454
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Fax | 623-214-3455
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Provider Business Mailing Address
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Address Line | 15653 N REEMS RD STE 110
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City | SURPRISE
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State | AZ
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Zip | 85374-9541
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Country | US
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Telephone | 623-214-3454
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Fax | 623-214-3455
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DENICE M YOUNG
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Credential |
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Telephone | 623-214-3454
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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 | 33964
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License Number State | AZ
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