Provider Demographics
NPI:1558371526
Name:WOMAN AND CHILD HEALTH, PC
Entity Type:Organization
Organization Name:WOMAN AND CHILD HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:D
Authorized Official - Last Name:KAZNOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-854-8100
Mailing Address - Street 1:1851 MESQUITE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5677
Mailing Address - Country:US
Mailing Address - Phone:928-854-8100
Mailing Address - Fax:928-854-8182
Practice Address - Street 1:1851 MESQUITE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5677
Practice Address - Country:US
Practice Address - Phone:928-854-8100
Practice Address - Fax:928-854-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ32330207VG0400X
AZAZ4026208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ212221Medicaid
AZ212221Medicaid