Provider Demographics
NPI:1649380205
Name:WEST PHOENIX PEDIATRICS PLC
Entity Type:Organization
Organization Name:WEST PHOENIX PEDIATRICS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CELIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-889-6186
Mailing Address - Street 1:9305 W THOMAS RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037
Mailing Address - Country:US
Mailing Address - Phone:623-889-6186
Mailing Address - Fax:623-889-6188
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:SUITE 450
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037
Practice Address - Country:US
Practice Address - Phone:623-889-6186
Practice Address - Fax:623-889-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34213208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2Z3015OtherHEALTHNET PPO
2Z3015OtherHEALTHNET POS
AZAZ078820OtherBCBS
AZ5655373OtherMERCY CARE
AZ46677OtherBANNER CHOICE PLUS
5655373OtherCCN
AZ0788280OtherCIGNA HELATHCARE
145458OtherGALAXY HEALTH NTWK
AZ078820OtherTRICARE
7672735OtherAETNA HEALTHCARE
AZ959223OtherAHCCCS
AZ0788280OtherCIGNA HELATHCARE