Organization
TEQUA MED-PEDS LLC
Active
Organization
TEQUA MED-PEDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TEQUA SALEHI-RAD D.O. (OWNER/MEMBER)
(928) 669-5550
Entity
Organization
Contact information
Practice address
601 W RIVERSIDE DR, PARKER, AZ 85344-5119
(928) 669-5550
Mailing address
3269 MARICOPA AVE, SUITE 114-239, LAKE HAVASU CITY, AZ 86406-8593
(928) 669-5550
(928) 669-0061
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5436
AZ
208000000X
Pediatrics Physician
5436
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L-1647527-7
AZ-LLC REGISTRATION #
AZ
Enumeration date
04/01/2012
Last updated
04/01/2012
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