Organization
PEDIATRAS ARIZONA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN C LLUSCO M.D. (OWNER/PRESIDENT)
(602) 218-6397
Entity
Organization
Contact information
Practice address
1641 E OSBORN RD, SUITE 3, PHOENIX, AZ 85016-7146
(602) 218-6397
(602) 281-6391
Mailing address
PO BOX 71608, PHOENIX, AZ 85050-1011
(602) 218-6397
(602) 281-6391
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
805872
AHCCCS
—
Enumeration date
09/12/2006
Last updated
11/29/2016
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