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General NPI Number Information
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NPI Number | 1588972301
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Entity Type | Organization
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Legal Business Name | PUEBLO PEDIATRICS, LLC
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 900 INDIANA AVE SUITE D
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City | PUEBLO
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State | CO
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Zip | 81004-3766
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Country | US
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Telephone | 719-404-3672
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Fax | 719-564-0374
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Provider Business Mailing Address
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Address Line | 200 S SANTA FE AVE SUITE 500
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City | PUEBLO
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State | CO
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Zip | 81003-4270
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Country | US
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Telephone | 719-296-5842
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Fax | 719-542-0746
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Authorized Official
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Title or Position | MANAGER
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Name | DR. QUAZI R PARVIN
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Credential | MD
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Telephone | 719-404-3665
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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 | 43488
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License Number State | CO
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