Provider Demographics
NPI:1083783724
Name:AZ PEDIATRIC CARE
Entity Type:Organization
Organization Name:AZ PEDIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:O
Authorized Official - Last Name:TAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:602-471-6521
Mailing Address - Street 1:5247 E WAGONER RD
Mailing Address - Street 2:SCOTTSDALE
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-7635
Mailing Address - Country:US
Mailing Address - Phone:602-471-6521
Mailing Address - Fax:
Practice Address - Street 1:9305 W THOMAS RD STE 410
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3369
Practice Address - Country:US
Practice Address - Phone:602-471-6521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32141261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care