Provider Demographics
NPI:1396193843
Name:DESERT PRINCESS
Entity Type:Organization
Organization Name:DESERT PRINCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-544-6900
Mailing Address - Street 1:8711 E PINNACLE PEAK RD
Mailing Address - Street 2:BOX 218
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3517
Mailing Address - Country:US
Mailing Address - Phone:480-559-4776
Mailing Address - Fax:866-526-7086
Practice Address - Street 1:5133 N CENTRAL AVE
Practice Address - Street 2:100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1438
Practice Address - Country:US
Practice Address - Phone:480-559-4776
Practice Address - Fax:866-526-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36773207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ203537Medicaid
AZZ197651Medicare PIN