1265202048 NPI number — KIDFINITY PC

Table of content: (NPI 1265202048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265202048 NPI number — KIDFINITY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDFINITY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIDFINITY PEDIATRICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265202048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11022 N 28TH DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85029-5634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-462-1981
Provider Business Mailing Address Fax Number:
623-400-3348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20221 N 67TH AVE STE E3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-0602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-462-1981
Provider Business Practice Location Address Fax Number:
623-400-3348
Provider Enumeration Date:
01/03/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MALHOTRA
Authorized Official First Name:
DEVIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
480-329-8796

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)