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Contact Information

PEDIATRIC MULTICARE WEST, LLC
316 W. WHITE MOUNTAIN BLVD.
SUITE A
LAKESIDE, AZ85929
 Phone: 928-358-4620
 Fax: 928-358-5319
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for PEDIATRIC MULTICARE WEST LLC · (Female)

NPI Number 1689272700
Status Active
Credentials
Entity Individual
Enumeration date 10/12/2020
Last updated 10/12/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • AZ Medicaid 619449
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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