Organization
PROVIDENCE PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOURDES RODRIGUEZ (BILLING)
(602) 254-7077
Entity
Organization
Contact information
Practice address
9100 N CENTRAL AVE, SUITE E, PHOENIX, AZ 85020-2430
(602) 997-9898
(602) 997-9901
Mailing address
9100 N CENTRAL AVE, SUITE E, PHOENIX, AZ 85020-2430
(602) 997-9898
(602) 997-9901
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
531881
—
AZ
Enumeration date
03/19/2008
Last updated
03/19/2008
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