Healthcare Provider Details

I. General information

NPI: 1295785418
Provider Name (Legal Business Name): SAGUARO CHILDREN'S SURGERY LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E CAMBRIDGE AVE SUITE #201
PHOENIX AZ
85006-1459
US

IV. Provider business mailing address

1920 E CAMBRIDGE AVE SUITE#201
PHOENIX AZ
85006-1459
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-5516
  • Fax: 602-254-2185
Mailing address:
  • Phone: 602-254-5561
  • Fax: 602-258-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAZ

VIII. Authorized Official

Name: MS. JULIE D LYNCH
Title or Position: CREDENTIALING
Credential: CPCS
Phone: 602-294-6311