MEDICARE: WOMAN AND CHILD HEALTH, PC

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	207VG0400X	Gynecology Physician	AZ32330	AZ
2	208000000X	Pediatrics Physician	AZ4026	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558371526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMAN AND CHILD HEALTH, PC

Provider Business Mailing Address
First Line	:	1851 MESQUITE AVE
Second Line	:	SUITE 210
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5677
Country	:	US
Telephone Number	:	928-854-8100
Fax Number	:	928-854-8182

Provider Business Practice Location Address
First Line	:	1851 MESQUITE AVE
Second Line	:	SUITE 210
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5677
Country	:	US
Telephone Number	:	928-854-8100
Fax Number	:	928-854-8182

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEREK D KAZNOSKI
Credential	:	M.D.
Telephone Number	:	928-854-8100

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	09/11/2025

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Directions to “WOMAN AND CHILD HEALTH, PC ” Practice Location

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