Provider Demographics
NPI:1609132828
Name:FOOTHILLS PEDIATRICS, LLC.
Entity Type:Organization
Organization Name:FOOTHILLS PEDIATRICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-614-5437
Mailing Address - Street 1:6301 MOUNTAIN VISTA ST
Mailing Address - Street 2:SUITE #205
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2364
Mailing Address - Country:US
Mailing Address - Phone:702-614-5437
Mailing Address - Fax:702-990-9922
Practice Address - Street 1:6301 MOUNTAIN VISTA ST
Practice Address - Street 2:SUITE #205
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2364
Practice Address - Country:US
Practice Address - Phone:702-614-5437
Practice Address - Fax:702-990-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty