Provider Demographics
NPI:1093033110
Name:SOUTHWESTERN PEDIATRICSPLLC
Entity Type:Organization
Organization Name:SOUTHWESTERN PEDIATRICSPLLC
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 1:21300 N JOHN WAYNE PKWY STE 109
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-8964
Mailing Address - Country:US
Mailing Address - Phone:520-568-9500
Mailing Address - Fax:520-568-9533
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 109
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8964
Practice Address - Country:US
Practice Address - Phone:520-568-9500
Practice Address - Fax:520-568-9533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWESTERN PEDIATRICS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty