MEDICARE: LOUIS BEDOYA

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	385HR2055X	Child Mental Illness Respite Care	7173970	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7173970	OTHER	AZ	AZ DEPT OF HEALTH SERVICES

General Provider Information

NPI Number	:	1912469453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS BEDOYA

Provider Business Mailing Address
First Line	:	33727 S COLONY DR
Second Line	:
City	:	RED ROCK
State	:	AZ
Zip	:	85145-5044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33727 S COLONY DR
Second Line	:
City	:	RED ROCK
State	:	AZ
Zip	:	85145-5044
Country	:	US
Telephone Number	:	520-404-2232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	04/03/2019

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Directions to “ LOUIS BEDOYA ” Practice Location

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