Provider Demographics
NPI:1033437439
Name:SOUTHWESTERN PEDIATRICS PLLC
Entity Type:Organization
Organization Name:SOUTHWESTERN PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DENOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-857-6316
Mailing Address - Street 1:2730 S VAL VISTA DR STE 161
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1680
Mailing Address - Country:US
Mailing Address - Phone:480-857-6316
Mailing Address - Fax:480-857-6638
Practice Address - Street 1:2730 S VAL VISTA DR STE 161
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1680
Practice Address - Country:US
Practice Address - Phone:480-857-6316
Practice Address - Fax:480-857-6638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWESTERN PEDIATRICS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty