MEDICARE: PEDIATRAS ARIZONA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	805872	OTHER		AHCCCS

General Provider Information

NPI Number	:	1427152164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRAS ARIZONA

Provider Business Mailing Address
First Line	:	PO BOX 71608
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-1011
Country	:	US
Telephone Number	:	602-218-6397
Fax Number	:	602-281-6391

Provider Business Practice Location Address
First Line	:	1641 E OSBORN RD
Second Line	:	SUITE 3
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7146
Country	:	US
Telephone Number	:	602-218-6397
Fax Number	:	602-281-6391

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. JUAN C LLUSCO
Credential	:	M.D.
Telephone Number	:	602-218-6397

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	11/29/2016

Similar Medicare Providers

1669464210 — JUAN LLUSCO MD
Practice Location Address:

1641 E OSBORN RD , SUITE 3
PHOENIX, AZ
85016-7146

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Practice Fax:

1861462376 — DR. KAREN ANTOINETTE VAUGHAN NMD
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1641 E OSBORN RD , SUITE 6
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1215907720 — DR. JULIE ANN GORMAN NMD
Practice Location Address:

1641 E OSBORN RD , SUITE 6
PHOENIX, AZ
85016-7146

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Practice Fax: 602-265-1738

1063448389 — KAVITA SAGGAR P.A.
Practice Location Address:

1641 E OSBORN RD STE 4
PHOENIX, AZ
85016-7146

Practice Phone: 480-630-2886
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1598839458 — HANGER PROSTHETICS & ORTHOTICS WEST INC
Practice Location Address:

1641 E OSBORN RD STE 4
PHOENIX, AZ
85016-7146

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Practice Fax:

1699897041 — REVOLUTION HEALTH MEDICAL CENTER, PC
Practice Location Address:

1641 E OSBORN RD , SUITE 6
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85016-7146

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Practice Fax: 602-265-1738

Directions to “PEDIATRAS ARIZONA ” Practice Location

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