Provider Demographics
NPI:1871041863
Name:DESERT WILLOW PEDIATRICS, PLLC.
Entity Type:Organization
Organization Name:DESERT WILLOW PEDIATRICS, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PESKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-751-4124
Mailing Address - Street 1:6369 E TANQUE VERDE RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3850
Mailing Address - Country:US
Mailing Address - Phone:520-751-4124
Mailing Address - Fax:
Practice Address - Street 1:6369 E TANQUE VERDE RD
Practice Address - Street 2:SUITE 190
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3850
Practice Address - Country:US
Practice Address - Phone:520-751-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ19520OtherLICENSE