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General NPI Number Information
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NPI Number | 1437340098
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Entity Type | Organization
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Legal Business Name | HAVASU RAINBOW PEDIATRICS
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1980 MESQUITE AVE STE 101
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-7713
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Country | US
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Telephone | 928-680-1919
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Fax | 928-680-0488
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Provider Business Mailing Address
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Address Line | 1980 MESQUITE AVE STE 101
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-7713
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Country | US
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Telephone | 928-680-1919
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Fax | 928-680-0488
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARIA B OYAS
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Credential |
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Telephone | 928-680-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | AZ
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