Organization
BETHESDA PEDIATRICS OF QUEEN CREEK
Active
Other names
Pediatrics of Queen Creek
Organization subpart
No
Provider details
NPI number
Authorized official
ELMER PORTILLO (CFO)
(602) 531-0302
Entity
Organization
Contact information
Practice address
22707 S ELLSWORTH RD STE H101, QUEEN CREEK, AZ 85142-7568
(480) 792-9200
(480) 792-9206
Mailing address
22707 S ELLSWORTH RD STE H101, QUEEN CREEK, AZ 85142-7568
(480) 792-9200
(480) 792-9206
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
43623
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
935531
—
AZ
Enumeration date
08/18/2010
Last updated
07/24/2024
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