Provider Demographics
NPI:1639760853
Name:SUMMIT PEDIATRIC ANESTHESIA PLLC
Entity Type:Organization
Organization Name:SUMMIT PEDIATRIC ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FUJII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-954-4575
Mailing Address - Street 1:2942 N 24TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7849
Mailing Address - Country:US
Mailing Address - Phone:602-954-4575
Mailing Address - Fax:
Practice Address - Street 1:1920 E CAMBRIDGE AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1461
Practice Address - Country:US
Practice Address - Phone:602-933-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty