Provider Demographics
NPI:1578345500
Name:DESOTO PEDIATRICS PA
Entity Type:Organization
Organization Name:DESOTO PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:ARIYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-282-6710
Mailing Address - Street 1:3213 DREXEL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-2912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2617 BOLTON BOONE DR STE B
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2075
Practice Address - Country:US
Practice Address - Phone:214-282-6710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty