Children's Clinic of Pueblo, PC

NPI #1962553172 in Pueblo, Colorado

Provider Information

NPI Number: 1962553172
Entity Type: Organization
Organization Name: Children's Clinic of Pueblo, PC
Primary Specialty: Pediatrics
Enumeration Date: Jan 15, 2007
Last Updated: Dec 9, 2011

Practice Location

Address: 1600 N GRAND AVE
Address 2: SUITE 240
City: Pueblo
State: Colorado
ZIP Code: 81003-2700
Phone: (719) 295-2305

Authorized Official

Name: LORAINE L. CARROLL, M.D.
Title: PHYSICIAN
Phone: (719) 295-2305

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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