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General NPI Number Information
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NPI Number | 1639321458
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Entity Type | Organization
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Legal Business Name | TEDDY BEAR PEDIATRICS, LLC
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 10/13/2008
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Provider Practice Location Address
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Address Line | 15415 W MAUNA LOA LN
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City | SURPRISE
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State | AZ
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Zip | 85379-6081
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Country | US
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Telephone | 480-699-5826
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Fax |
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Provider Business Mailing Address
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Address Line | 15415 W MAUNA LOA LN
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City | SURPRISE
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State | AZ
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Zip | 85379-6081
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE CONSULTANT
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Name | ENEY GARCIA
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Credential |
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Telephone | 480-699-5826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP5015
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License Number State | AZ
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