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General NPI Number Information
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NPI Number | 1619338167
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Entity Type | Organization
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Legal Business Name | BOYS AND GIRLS PEDIATRIC PC
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 2727 W BASELINE RD SUITE 11
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City | TEMPE
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State | AZ
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Zip | 85283-1067
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Country | US
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Telephone | 602-714-5064
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Fax | 602-714-5314
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Provider Business Mailing Address
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Address Line | 2727 W BASELINE RD SUITE 11
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City | TEMPE
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State | AZ
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Zip | 85283-1067
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Country | US
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Telephone | 602-714-5064
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Fax | 602-714-5314
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ENRIQUE M CIFUENTES
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Credential |
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Telephone | 602-714-5064
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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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