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General NPI Number Information
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NPI Number | 1467779355
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Entity Type | Organization
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Legal Business Name | SPECIALTY PEDIATRICS LT
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Dates
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Enumeration Date | 05/01/2010
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Last Update Date | 05/01/2010
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Provider Practice Location Address
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Address Line | 2851 S AVE B STE B
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City | YUMA
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State | AZ
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Zip | 85364-7726
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Country | US
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Telephone | 928-726-3009
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Fax | 928-726-3019
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Provider Business Mailing Address
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Address Line | 2851 S AVE B STE B
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City | YUMA
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State | AZ
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Zip | 85364-7726
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Country | US
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Telephone | 928-726-3009
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Fax | 928-726-3019
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Authorized Official
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Title or Position | MEMBER
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Name | MOINUDDIN H MOKHASHI
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Credential | M.D.
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Telephone | 928-726-3009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 34699
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License Number State | AZ
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