Healthcare Provider Details

I. General information

NPI: 1326196858
Provider Name (Legal Business Name): FOUNTAIN HILLS PEDIATRICS AND INTERNAL MEDICINE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13620 N SAGUARO BLVD STE 50
FOUNTAIN HILLS AZ
85268-8551
US

IV. Provider business mailing address

PO BOX 20019
FOUNTAIN HILLS AZ
85269-0019
US

V. Phone/Fax

Practice location:
  • Phone: 480-837-6800
  • Fax: 480-837-6804
Mailing address:
  • Phone: 480-837-6800
  • Fax: 480-837-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JYOTI PATEL
Title or Position: OWNER, MEMBER
Credential: MD
Phone: 480-837-6800