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General NPI Number Information
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NPI Number | 1558085498
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS PEDIATRIC CLINIC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 5400 W NORTHERN AVE STE 101
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City | GLENDALE
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State | AZ
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Zip | 85301-1590
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Country | US
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Telephone | 480-847-0900
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Fax | 480-508-7815
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Provider Business Mailing Address
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Address Line | 1755 N PEBBLE CREEK PKWY PMB1058
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City | GOODYEAR
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State | AZ
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Zip | 85395-2532
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Country | US
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Telephone | 480-847-0900
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Fax | 480-508-7815
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | DR. NAILAH COOPER
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Credential | MD
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Telephone | 480-847-0900
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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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