Organization
PEDIATRIC MULTICARE WEST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA ANNE RAFFLE (BILLING MANAGER)
(928) 242-1503
Entity
Organization
Contact information
Practice address
316 W. WHITE MOUNTAIN BLVD., SUITE A, LAKESIDE, AZ 85929
(928) 358-4620
(928) 358-5319
Mailing address
316 W. WHITE MOUNTAIN BLVD., SUITE A, LAKESIDE, AZ 85929
(928) 358-4620
(928) 358-5319
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
619449
—
AZ
Enumeration date
10/12/2020
Last updated
10/12/2020
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