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General NPI Number Information
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NPI Number | 1528973534
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Entity Type | Organization
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Legal Business Name | HAVASU RAINBOW PEDIATRICS AND ASSOCIATES PLLC
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Dates
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Enumeration Date | 08/14/2026
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Last Update Date | 08/14/2026
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Provider Practice Location Address
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Address Line | 150 RIVIERA DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5735
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Country | US
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Telephone | 928-540-5437
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Fax | 928-540-5438
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Provider Business Mailing Address
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Address Line | 150 RIVIERA DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5735
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Country | US
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Telephone | 928-540-5437
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Fax | 928-540-5438
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | MARY RENEE GOLDEN
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Credential | DNP
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Telephone | 317-414-5202
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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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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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