Provider Demographics
NPI:1710318019
Name:HEALTHY KIDZ PEDIATRICS LLC
Entity Type:Organization
Organization Name:HEALTHY KIDZ PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:MEZA
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-628-8064
Mailing Address - Street 1:215 S POWER RD
Mailing Address - Street 2:SUITE # 106
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5235
Mailing Address - Country:US
Mailing Address - Phone:480-214-0051
Mailing Address - Fax:480-214-0055
Practice Address - Street 1:215 S POWER RD
Practice Address - Street 2:SUITE # 106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5235
Practice Address - Country:US
Practice Address - Phone:480-214-0051
Practice Address - Fax:480-214-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty