Provider Demographics
NPI:1457677262
Name:SULTAN Y. AYOUB FNP PLLC
Entity Type:Organization
Organization Name:SULTAN Y. AYOUB FNP PLLC
Other - Org Name:SOUTHWESTERN PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SULTAN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:FNP - BC
Authorized Official - Phone:480-720-9667
Mailing Address - Street 1:21300 N JOHN WAYNE PKWY STE 112
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:2010-04-19
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty