Provider Demographics
NPI:1467779355
Name:SPECIALTY PEDIATRICS LT
Entity Type:Organization
Organization Name:SPECIALTY PEDIATRICS LT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOINUDDIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOKHASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-726-3009
Mailing Address - Street 1:2851 S AVE B
Mailing Address - Street 2:STE B
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7726
Mailing Address - Country:US
Mailing Address - Phone:928-726-3009
Mailing Address - Fax:928-726-3019
Practice Address - Street 1:2851 S AVE B
Practice Address - Street 2:STE B
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7726
Practice Address - Country:US
Practice Address - Phone:928-726-3009
Practice Address - Fax:928-726-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34699261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty