Provider Demographics
NPI:1386833119
Name:PRAISE PEDIATRICS LLC
Entity Type:Organization
Organization Name:PRAISE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-855-0520
Mailing Address - Street 1:PO BOX 3502
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-3502
Mailing Address - Country:US
Mailing Address - Phone:928-855-0520
Mailing Address - Fax:928-855-0537
Practice Address - Street 1:84 ACOMA BLVD N
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6096
Practice Address - Country:US
Practice Address - Phone:928-855-0520
Practice Address - Fax:928-855-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZL13964732OtherLLC REGISTRATION #