Provider Demographics
NPI:1922295013
Name:PALM TREE PEDIATRICS PLC
Entity Type:Organization
Organization Name:PALM TREE PEDIATRICS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINULOA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BABARINDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-975-5400
Mailing Address - Street 1:14506 W GRANITE VALLEY DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6010
Mailing Address - Country:US
Mailing Address - Phone:623-975-5400
Mailing Address - Fax:623-975-6004
Practice Address - Street 1:14506 W GRANITE VALLEY DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6010
Practice Address - Country:US
Practice Address - Phone:623-975-5400
Practice Address - Fax:623-975-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29580208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1265594519OtherNPI
AZ625246Medicaid