Provider Demographics
NPI:1508931593
Name:KIDSHEALTH PEDIATRICS PLLC
Entity Type:Organization
Organization Name:KIDSHEALTH PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARIANO-NABONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-390-0395
Mailing Address - Street 1:5425 E BELL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6007
Mailing Address - Country:US
Mailing Address - Phone:602-374-3396
Mailing Address - Fax:602-374-3177
Practice Address - Street 1:5425 E BELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6007
Practice Address - Country:US
Practice Address - Phone:602-374-3396
Practice Address - Fax:602-374-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ329584Medicaid
AZ329584Medicaid