Provider Demographics
NPI:1700373180
Name:COOLIDGE PEDIATRICS
Entity Type:Organization
Organization Name:COOLIDGE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ-VIEYTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-792-9200
Mailing Address - Street 1:22707 S ELLSWORTH RD STE H101
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7568
Mailing Address - Country:US
Mailing Address - Phone:480-792-9200
Mailing Address - Fax:480-792-9206
Practice Address - Street 1:299 W CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-4726
Practice Address - Country:US
Practice Address - Phone:480-792-9200
Practice Address - Fax:480-792-9206
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHESDA PEDIATRICS OF QUEEN CREEK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43623208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty