Tequa Med-Peds LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5436 Issued in AZ

Legal business name

TEQUA MED-PEDS LLC

Practice address

601 W Riverside Dr
Parker, AZ 85344-5119

Phone

(928) 669-5550

NPI assigned

Apr 1, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tequa Salehi-Rad, D.O.

Title

Owner/Member

Phone

(928) 669-5550

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333238400000",
    "number": "1497021679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3269 MARICOPA AVE",
            "address_2": "SUITE 114-239",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864068593",
            "telephone_number": "928-669-5550",
            "fax_number": "928-669-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W RIVERSIDE DR",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853445119",
            "telephone_number": "928-669-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEQUA MED-PEDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-01",
        "last_updated": "2012-04-01",
        "status": "A",
        "authorized_official_last_name": "SALEHI-RAD",
        "authorized_official_first_name": "TEQUA",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "928-669-5550",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "5436",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "5436",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ-LLC REGISTRATION #",
            "identifier": "L-1647527-7",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.