Healthcare Provider Details

I. General information

NPI: 1003905183
Provider Name (Legal Business Name): ERIC L PEDICINI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 N CENTRAL AVE SUITE1600
PHOENIX AZ
85004-4527
US

IV. Provider business mailing address

1850 N CENTRAL AVE SUITE 1600
PHOENIX AZ
85004-4527
US

V. Phone/Fax

Practice location:
  • Phone: 602-262-8900
  • Fax: 602-262-8890
Mailing address:
  • Phone: 602-262-8900
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036082979
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number005038
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: