Healthcare Provider Details

I. General information

NPI: 1154440444
Provider Name (Legal Business Name): ORO VALLEY PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 E INNOVATION PARK DR
ORO VALLEY AZ
85755-1963
US

IV. Provider business mailing address

1856 E INNOVATION PARK DR
ORO VALLEY AZ
85755-1963
US

V. Phone/Fax

Practice location:
  • Phone: 520-825-7111
  • Fax: 520-818-1253
Mailing address:
  • Phone: 520-825-7111
  • Fax: 520-818-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CONNIE J HALL
Title or Position: OFFICE MANAGER
Credential:
Phone: 520-825-7111