Provider Demographics
NPI:1063786812
Name:MED-PEDS OF YUMA, PLLC
Entity type:Organization
Organization Name:MED-PEDS OF YUMA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAHD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-ALOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-366-1026
Mailing Address - Street 1:2435 S AVENUE A STE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7176
Mailing Address - Country:US
Mailing Address - Phone:928-366-1026
Mailing Address - Fax:928-366-1028
Practice Address - Street 1:2435 S AVENUE A STE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7176
Practice Address - Country:US
Practice Address - Phone:928-366-1026
Practice Address - Fax:928-366-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-25
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45521207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP1679517858OtherINDIVIDUAL NPI
MP1679517858OtherINDIVIDUAL NPI