Provider Demographics
NPI:1821064353
Name:PUEBLO PEDIATRICS LTD
Entity Type:Organization
Organization Name:PUEBLO PEDIATRICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CHILES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-732-0044
Mailing Address - Street 1:2152 S VINEYARD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6871
Mailing Address - Country:US
Mailing Address - Phone:480-732-0044
Mailing Address - Fax:480-732-9333
Practice Address - Street 1:2152 S VINEYARD
Practice Address - Street 2:SUITE 129
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6871
Practice Address - Country:US
Practice Address - Phone:480-732-0044
Practice Address - Fax:480-732-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty