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General NPI Number Information
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NPI Number | 1427152164
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Entity Type | Organization
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Legal Business Name | PEDIATRAS ARIZONA
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 1641 E OSBORN RD SUITE 3
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City | PHOENIX
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State | AZ
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Zip | 85016-7146
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Country | US
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Telephone | 602-218-6397
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Fax | 602-281-6391
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Provider Business Mailing Address
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Address Line | PO BOX 71608
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City | PHOENIX
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State | AZ
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Zip | 85050-1011
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Country | US
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Telephone | 602-218-6397
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Fax | 602-281-6391
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JUAN C LLUSCO
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Credential | M.D.
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Telephone | 602-218-6397
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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 |
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License Number State |
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