Provider Demographics
NPI:1619338167
Name:BOYS AND GIRLS PEDIATRIC PC
Entity Type:Organization
Organization Name:BOYS AND GIRLS PEDIATRIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CIFUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-714-5064
Mailing Address - Street 1:2727 W BASELINE RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1067
Mailing Address - Country:US
Mailing Address - Phone:602-714-5064
Mailing Address - Fax:602-714-5314
Practice Address - Street 1:2727 W BASELINE RD
Practice Address - Street 2:SUITE 11
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1067
Practice Address - Country:US
Practice Address - Phone:602-714-5064
Practice Address - Fax:602-714-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty