Provider Demographics
NPI:1871653550
Name:YUMA PEDIATRICS
Entity Type:Organization
Organization Name:YUMA PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:TUDOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-344-4800
Mailing Address - Street 1:2359 22ND DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-344-4800
Mailing Address - Fax:928-726-2377
Practice Address - Street 1:2359 22ND DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-344-4800
Practice Address - Fax:928-726-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ22611208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ186082 02Medicaid
AZAZ0715400OtherBCBC