| Kids Kare Pediatrics PC | |
|
521 W Thomas Rd 2nd Floor Phoenix AZ 85013-4240 | |
| (602) 867-1252 | |
| (602) 867-1256 |
| Full Name | Kids Kare Pediatrics PC |
|---|---|
| Speciality | Pediatrics |
| Location | 521 W Thomas Rd, Phoenix, Arizona |
| Authorized Official Name and Position | Luz Angela Lopez (VICEPRESIDENT) |
| Authorized Official Contact | 6028671252 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kids Kare Pediatrics PC 521 W Thomas Rd 2nd Floor Phoenix AZ 85013-4240 Ph: (602) 867-1252 | Kids Kare Pediatrics PC 521 W Thomas Rd 2nd Floor Phoenix AZ 85013-4240 Ph: (602) 867-1252 |
| NPI Number | 1508829326 |
|---|---|
| Provider Enumeration Date | 04/11/2006 |
| Last Update Date | 06/10/2014 |
| Medicare PECOS PAC ID | 1658595806 |
|---|---|
| Medicare Enrollment ID | O20140610001454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508829326 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Secondary |
| 208000000X | Pediatrics | (NU) | Primary |
| Provider Name | Will Innocent |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659471555 PECOS PAC ID: 2668456880 Enrollment ID: I20040617001105 |
| Provider Name | Carlos J Lopez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952309320 PECOS PAC ID: 3870511629 Enrollment ID: I20051109001213 |
| Provider Name | Tanya C Cavallaro Moretti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265761399 PECOS PAC ID: 8325236250 Enrollment ID: I20101220000731 |
| Provider Name | Melinda S Baehr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114344157 PECOS PAC ID: 9830313303 Enrollment ID: I20140624001921 |
| Provider Name | Lourdes Colin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033457023 PECOS PAC ID: 2860617354 Enrollment ID: I20140625000356 |
| Provider Name | Tahsia L Pest |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1437574712 PECOS PAC ID: 2769601855 Enrollment ID: I20140923001141 |
| Provider Name | Grace Hannon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1497156327 PECOS PAC ID: 3678897519 Enrollment ID: I20150123000881 |
| Provider Name | Celeste J Olmos |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962873059 PECOS PAC ID: 9537455274 Enrollment ID: I20160907001359 |
| Provider Name | Lorena De La Rosa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689124752 PECOS PAC ID: 1759660533 Enrollment ID: I20171016000250 |
| Provider Name | Patricia I Herrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902304801 PECOS PAC ID: 3779848932 Enrollment ID: I20180711003677 |
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