| Waddell Family Care | |
|
13755 N Litchfield Rd Ste 105 Surprise AZ 85379-4288 | |
| (623) 512-8308 | |
| (949) 437-2917 |
| Full Name | Waddell Family Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 13755 N Litchfield Rd Ste 105, Surprise, Arizona |
| Authorized Official Name and Position | Kandy Lizzeth Medina Perez (OWNER/PROVIDER) |
| Authorized Official Contact | 6235128308 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waddell Family Care 7908 N Cotton Ln Waddell AZ 85355-9751 Ph: (623) 512-8308 | Waddell Family Care 13755 N Litchfield Rd Ste 105 Surprise AZ 85379-4288 Ph: (623) 512-8308 |
| NPI Number | 1144974395 |
|---|---|
| Provider Enumeration Date | 02/07/2022 |
| Last Update Date | 09/11/2023 |
| Medicare PECOS PAC ID | 6901283779 |
|---|---|
| Medicare Enrollment ID | O20220517000623 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144974395 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kandy L Medina Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972186138 PECOS PAC ID: 0244627347 Enrollment ID: I20220517000941 |
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