Healthcare Provider Details

I. General information

NPI: 1548253529
Provider Name (Legal Business Name): ARIZONA PEDIATRIC HEMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 S DOBSON RD STE 107
MESA AZ
85202-4768
US

IV. Provider business mailing address

1432 S DOBSON RD STE 107
MESA AZ
85202-4768
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-1123
  • Fax: 480-833-1124
Mailing address:
  • Phone: 480-833-1123
  • Fax: 480-833-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: LORI LINDER
Title or Position: SECRETARY TREASURER
Credential:
Phone: 480-512-3214