Provider Demographics
NPI:1841263704
Name:ARIZONA PEDIATRIC PULMONARY & ASTHMA ASSOCIATES, P.L.C.
Entity type:Organization
Organization Name:ARIZONA PEDIATRIC PULMONARY & ASTHMA ASSOCIATES, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEGRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:602-200-9159
Mailing Address - Street 1:500 W THOMAS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4215
Mailing Address - Country:US
Mailing Address - Phone:602-200-9159
Mailing Address - Fax:602-200-9949
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-200-9159
Practice Address - Fax:602-200-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ61559Medicare PIN