MEDICARE: PLEASANT PEDIATRICS PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1639627789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT PEDIATRICS PLC

Provider Business Mailing Address
First Line	:	9059 W LAKE PLEASANT PKWY
Second Line	:	SUITE E540
City	:	PEORIA
State	:	AZ
Zip	:	85382-8336
Country	:	US
Telephone Number	:	623-322-3380
Fax Number	:	623-322-4399

Provider Business Practice Location Address
First Line	:	2932 N 14TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5601
Country	:	US
Telephone Number	:	623-322-3380
Fax Number	:	623-322-4399

Authorized Official
Title or Position	:	OWNER/PRACTICE MANAGER
Name	:	PRASAD RAVI
Credential	:
Telephone Number	:	623-234-3242

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	09/19/2016

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Directions to “PLEASANT PEDIATRICS PLC ” Practice Location

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