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General NPI Number Information
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NPI Number | 1649380205
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Entity Type | Organization
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Legal Business Name | WEST PHOENIX PEDIATRICS PLC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 9305 W THOMAS RD SUITE 450
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City | PHOENIX
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State | AZ
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Zip | 85037
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Country | US
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Telephone | 623-889-6186
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Fax | 623-889-6188
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Provider Business Mailing Address
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Address Line | 9305 W THOMAS RD SUITE 450
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City | PHOENIX
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State | AZ
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Zip | 85037
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Country | US
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Telephone | 623-889-6186
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Fax | 623-889-6188
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Authorized Official
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Title or Position | MEMBER
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Name | CELIDA RANGEL
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Credential | MD
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Telephone | 623-889-6186
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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 | 34213
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License Number State | AZ
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