Provider Demographics
NPI:1174913826
Name:ARIZONA PEDIATRIC PLLC
Entity type:Organization
Organization Name:ARIZONA PEDIATRIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAUCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-277-5731
Mailing Address - Street 1:22 E MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2340
Mailing Address - Country:US
Mailing Address - Phone:602-277-5731
Mailing Address - Fax:
Practice Address - Street 1:22 E MITCHELL DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2340
Practice Address - Country:US
Practice Address - Phone:602-277-5731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty