Provider Demographics
NPI:1679851455
Name:CORNERSTONE PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:CORNERSTONE PEDIATRICS, P.C.
Other - Org Name:CORNERSTONE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-443-5599
Mailing Address - Street 1:7875 E FLORENTINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2284
Mailing Address - Country:US
Mailing Address - Phone:928-443-5599
Mailing Address - Fax:928-443-5376
Practice Address - Street 1:7875 E FLORENTINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2284
Practice Address - Country:US
Practice Address - Phone:928-443-5599
Practice Address - Fax:928-443-5376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care