EDGEWOOD PEDIATRIC CLINIC L.L.C. NPI 1699905927

NPI Details

EDGEWOOD PEDIATRIC CLINIC L.L.C. is a pediatrics in Edgewood, NM. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. EDGEWOOD PEDIATRIC CLINIC L.L.C. NPI is 1699905927. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2 EUNICE CT BLDG B
EDGEWOOD, NM
ZIP 87015-108
Phone: (505) 281-4620
Fax: (505) 281-0397

The provider's authorized official is Sharon Diane Garnand .
The authorized official title is Owner and has the following contact phone number (505) 281-4620.

The CLIA number assigned to this NPI record is 32D1103934 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/21/2009 and was last updated on 5/30/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available: