Provider Demographics
NPI:1790183564
Name:DESERT VIEW MEDICAL CENTER AND PEDIATRICS, CORP
Entity Type:Organization
Organization Name:DESERT VIEW MEDICAL CENTER AND PEDIATRICS, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ABEL
Authorized Official - Last Name:DALOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-279-2400
Mailing Address - Street 1:727 E BETHANY HOME RD STE B112
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2151
Mailing Address - Country:US
Mailing Address - Phone:602-279-2400
Mailing Address - Fax:602-279-5890
Practice Address - Street 1:727 E BETHANY HOME RD STE B112
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2151
Practice Address - Country:US
Practice Address - Phone:602-279-2400
Practice Address - Fax:602-279-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ980078Medicaid