Healthcare Provider Details
I. General information
NPI: 1225660467
Provider Name (Legal Business Name): PIMRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/05/2020
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2204 S DOBSON RD STE 102
MESA AZ
85202-6457
US
IV. Provider business mailing address
70 S VAL VISTA DR STE A3-618
GILBERT AZ
85296-0942
US
V. Phone/Fax
- Phone: 480-485-5166
- Fax: 877-991-6652
- Phone: 480-485-5166
- Fax: 877-991-6652
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 246QM0706X |
| Taxonomy | Medical Technologist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QI0500X |
| Taxonomy | Infusion Therapy Clinic/Center |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 291U00000X |
| Taxonomy | Clinical Medical Laboratory |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080P0207X |
| Taxonomy | Pediatric Hematology & Oncology Physician |
| License Number | |
| License Number State | |
| # 5 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
NICOLAS
PETERS
Title or Position: MANAGER/OWNER
Credential: MD
Phone: 480-485-5166