Provider Demographics
NPI:1336767342
Name:KIDSHEALTH PEDIATRICS PLLC(GLENDALE)
Entity Type:Organization
Organization Name:KIDSHEALTH PEDIATRICS PLLC(GLENDALE)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LOUELLA
Authorized Official - Last Name:NABONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-374-3396
Mailing Address - Street 1:5425 E BELL RD STE 131
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6010
Mailing Address - Country:US
Mailing Address - Phone:602-374-3396
Mailing Address - Fax:
Practice Address - Street 1:5750 W THUNDERBIRD RD STE F620
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4690
Practice Address - Country:US
Practice Address - Phone:602-374-3396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDSHEALTH PEDIATRICS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty