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General NPI Number Information
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NPI Number | 1821326224
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Entity Type | Organization
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Legal Business Name | ROBINS NEST PEDIATRICS, PLLC
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 5171 CUB LAKE RD STE B280
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City | SHOW LOW
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State | AZ
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Zip | 85901-7888
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Country | US
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Telephone | 928-537-3222
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Fax | 928-527-8215
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Provider Business Mailing Address
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Address Line | PO BOX 236
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City | LAKESIDE
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State | AZ
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Zip | 85929-0236
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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 | PHYSICIAN
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Name | ROBIN BROZ
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Credential | DO
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Telephone | 928-537-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4074
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License Number State | AZ
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