| Ohana Kids & Family Kare LLC | |
|
3130 E Baseline Rd Ste 103 Mesa AZ 85204-7290 | |
| (480) 539-7618 | |
| (480) 900-8884 |
| Full Name | Ohana Kids & Family Kare LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 3130 E Baseline Rd Ste 103, Mesa, Arizona |
| Authorized Official Name and Position | Luz Angela Lopez (PRESIDENT) |
| Authorized Official Contact | 4808894565 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ohana Kids & Family Kare LLC 3130 E Baseline Rd Ste 103 Mesa AZ 85204-7290 Ph: (480) 539-7618 | Ohana Kids & Family Kare LLC 3130 E Baseline Rd Ste 103 Mesa AZ 85204-7290 Ph: (480) 539-7618 |
| NPI Number | 1003356320 |
|---|---|
| Provider Enumeration Date | 03/06/2017 |
| Last Update Date | 09/06/2023 |
| Certification Date | 06/01/2020 |
| Medicare PECOS PAC ID | 5193156438 |
|---|---|
| Medicare Enrollment ID | O20200520002478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003356320 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Klint L Webb |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1649507088 PECOS PAC ID: 5092939561 Enrollment ID: I20140624002011 |
| Provider Name | Luz a Lopez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124081823 PECOS PAC ID: 4789808775 Enrollment ID: I20140715001471 |
| Provider Name | Laura a Andersen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1710061171 PECOS PAC ID: 1951527076 Enrollment ID: I20140725002415 |
| Provider Name | Sardis Duany Caises |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518680412 PECOS PAC ID: 3779950357 Enrollment ID: I20230804001786 |
| Provider Name | Simon Pedro Jacquez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336820976 PECOS PAC ID: 0345603908 Enrollment ID: I20230829004272 |
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