Provider Demographics
NPI:1417841800
Name:DESERT IV THERAPY
Entity type:Organization
Organization Name:DESERT IV THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PUEBLA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:602-471-2188
Mailing Address - Street 1:423 W GARY WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-8031
Mailing Address - Country:US
Mailing Address - Phone:602-471-2188
Mailing Address - Fax:
Practice Address - Street 1:141 E PALM LN STE 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1555
Practice Address - Country:US
Practice Address - Phone:602-652-2962
Practice Address - Fax:800-572-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty