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General NPI Number Information
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NPI Number | 1710318019
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Entity Type | Organization
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Legal Business Name | HEALTHY KIDZ PEDIATRICS LLC
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 215 S POWER RD SUITE # 106
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City | MESA
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State | AZ
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Zip | 85206-5235
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Country | US
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Telephone | 480-214-0051
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Fax | 480-214-0055
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Provider Business Mailing Address
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Address Line | 215 S POWER RD SUITE # 106
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City | MESA
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State | AZ
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Zip | 85206-5235
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Country | US
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Telephone | 480-214-0051
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Fax | 480-214-0055
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. RAMON MEZA CARRASCO
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Credential | M.D.
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Telephone | 602-628-8064
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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 | 24255
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License Number State | AZ
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