Healthcare Provider Details

I. General information

NPI: 1376921106
Provider Name (Legal Business Name): PLEASANT PEDIATRICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 W MYRTLE AVE
GLENDALE AZ
85301-2007
US

IV. Provider business mailing address

9059 W LAKE PLEASANT PKWY #E-540
PEORIA AZ
85382-8336
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-3380
  • Fax:
Mailing address:
  • Phone: 623-322-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34320
License Number StateAZ

VIII. Authorized Official

Name: DR. SANDHYA RAVI
Title or Position: PROVIDER
Credential: MD
Phone: 623-322-3380