Provider Demographics
NPI:1518744218
Name:FAMILIES FIRST PEDIATRICS
Entity Type:Organization
Organization Name:FAMILIES FIRST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:EBONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-850-3769
Mailing Address - Street 1:5136 N CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0868
Mailing Address - Country:US
Mailing Address - Phone:801-254-9700
Mailing Address - Fax:
Practice Address - Street 1:5136 N CAMBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84095-0868
Practice Address - Country:US
Practice Address - Phone:801-254-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILIES FIRST PEDIATRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty