Provider Demographics
NPI:1598044406
Name:SUN VALLEY PEDIATRICS, PC
Entity Type:Organization
Organization Name:SUN VALLEY PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-228-1346
Mailing Address - Street 1:4045 W CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3732
Mailing Address - Country:US
Mailing Address - Phone:480-355-5437
Mailing Address - Fax:480-355-5436
Practice Address - Street 1:4045 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3732
Practice Address - Country:US
Practice Address - Phone:480-355-5437
Practice Address - Fax:480-355-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty