Healthcare Provider Details

I. General information

NPI: 1710139860
Provider Name (Legal Business Name): SONORAN SKY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10720 E SOUTHERN AVE SUITE 116
MESA AZ
85209-3810
US

IV. Provider business mailing address

10720 E SOUTHERN AVE SUITE 116
MESA AZ
85209-3810
US

V. Phone/Fax

Practice location:
  • Phone: 480-365-0050
  • Fax: 480-365-0049
Mailing address:
  • Phone: 480-365-0050
  • Fax: 480-365-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUTH E LETIZIA
Title or Position: OWNER
Credential: M.D.
Phone: 480-365-0050