Healthcare Provider Details

I. General information

NPI: 1396193843
Provider Name (Legal Business Name): DESERT PRINCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5133 N CENTRAL AVE 100
PHOENIX AZ
85012-1438
US

IV. Provider business mailing address

8711 E PINNACLE PEAK RD BOX 218
SCOTTSDALE AZ
85255-3517
US

V. Phone/Fax

Practice location:
  • Phone: 480-559-4776
  • Fax: 866-526-7086
Mailing address:
  • Phone: 480-559-4776
  • Fax: 866-526-7086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36773
License Number StateAZ

VIII. Authorized Official

Name: RICHARD DEMIR
Title or Position: OWNER
Credential: MD
Phone: 480-544-6900