Healthcare Provider Details

I. General information

NPI: 1356859128
Provider Name (Legal Business Name): PLEASANT PEDIATRICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 10/29/2022
Certification Date: 10/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 W HAPPY VALLEY PKWY STE 100
PEORIA AZ
85383-1389
US

IV. Provider business mailing address

9059 W LAKE PLEASANT PKWY STE E540
PEORIA AZ
85382-8396
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: PRASAD RAVI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 623-322-3380