| Glendale Pediatrics LLC | |
|
6745 N 51st Dr Glendale AZ 85301-3425 | |
| (623) 847-5300 | |
| (623) 847-5304 |
| Full Name | Glendale Pediatrics LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 6745 N 51st Dr, Glendale, Arizona |
| Authorized Official Name and Position | Enrique Sion Lopez (MEDICAL OFFICER) |
| Authorized Official Contact | 6238475300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glendale Pediatrics LLC 6745 N 51st Dr Glendale AZ 85301-3425 Ph: (623) 847-5300 | Glendale Pediatrics LLC 6745 N 51st Dr Glendale AZ 85301-3425 Ph: (623) 847-5300 |
| NPI Number | 1336335983 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 11/13/2024 |
| Certification Date | 11/13/2024 |
| Medicare PECOS PAC ID | 9133282502 |
|---|---|
| Medicare Enrollment ID | O20090112000153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336335983 | NPI | - | NPPES |
| 292340 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Enrique S Lopez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578572087 PECOS PAC ID: 8628131299 Enrollment ID: I20090107000549 |
| Provider Name | Diana Mendoza Noriega |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326522921 PECOS PAC ID: 7113110438 Enrollment ID: I20190405002229 |
| Provider Name | Manuel Gerardo Pompa |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1568080620 PECOS PAC ID: 3072911098 Enrollment ID: I20211006000346 |
| Provider Name | Ruth Montoya |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1437744950 PECOS PAC ID: 5294125530 Enrollment ID: I20211201000850 |
| Provider Name | Jacqueline Luna Bolin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1275119521 PECOS PAC ID: 9436540002 Enrollment ID: I20211216000455 |
| Provider Name | Araceli Rangel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437823945 PECOS PAC ID: 6204219090 Enrollment ID: I20220811000627 |
| Provider Name | Emily Arlene Rubio |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1093446478 PECOS PAC ID: 2163879925 Enrollment ID: I20231115003789 |
| Provider Name | Rebeca Flores-lopez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1114638129 PECOS PAC ID: 0446694558 Enrollment ID: I20240216001891 |
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