Provider Demographics
NPI:1770682353
Name:MESA PEDIATRICS PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:MESA PEDIATRICS PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELPHIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-214-2300
Mailing Address - Street 1:6301 S MCCLINTOCK DR
Mailing Address - Street 2:#101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3392
Mailing Address - Country:US
Mailing Address - Phone:480-214-2300
Mailing Address - Fax:480-214-2301
Practice Address - Street 1:6301 S MCCLINTOCK DR
Practice Address - Street 2:#101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3392
Practice Address - Country:US
Practice Address - Phone:480-214-2300
Practice Address - Fax:480-214-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty