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General NPI Number Information
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NPI Number | 1700373180
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Entity Type | Organization
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Legal Business Name | COOLIDGE PEDIATRICS
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 299 W CENTRAL AVE STE B
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City | COOLIDGE
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State | AZ
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Zip | 85128-4726
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Country | US
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Telephone | 480-792-9200
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Fax | 480-792-9206
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Provider Business Mailing Address
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Address Line | 22707 S ELLSWORTH RD STE H101
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-7568
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Country | US
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Telephone | 480-792-9200
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Fax | 480-792-9206
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Authorized Official
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Title or Position | CEO
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Name | EMILIA GOMEZ-VIEYTEZ
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Credential | MD
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Telephone | 480-792-9200
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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 | 43623
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License Number State | AZ
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