Provider Demographics
NPI:1790025591
Name:PLEASANT PEDIATRICS PLC
Entity Type:Organization
Organization Name:PLEASANT PEDIATRICS PLC
Other - Org Name:PLEASANT PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-322-3380
Mailing Address - Street 1:9059 W LAKE PLEASANT PKWY
Mailing Address - Street 2:SUITE E540
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8336
Mailing Address - Country:US
Mailing Address - Phone:623-322-3380
Mailing Address - Fax:
Practice Address - Street 1:9744 W NORTHERN AVE
Practice Address - Street 2:SUITE 1310
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-4603
Practice Address - Country:US
Practice Address - Phone:623-776-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34320208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ645732Medicaid