Provider Demographics
NPI:1518137165
Name:DESERT PERINATOLOGY, INC
Entity Type:Organization
Organization Name:DESERT PERINATOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-776-5489
Mailing Address - Street 1:1343 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5941
Mailing Address - Country:US
Mailing Address - Phone:480-776-5489
Mailing Address - Fax:480-726-0695
Practice Address - Street 1:1343 N ALMA SCHOOL RD
Practice Address - Street 2:STE 295
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5941
Practice Address - Country:US
Practice Address - Phone:480-496-2869
Practice Address - Fax:480-726-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty