Healthcare Provider Details

I. General information

NPI: 1134243330
Provider Name (Legal Business Name): DESERT SUN PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26224 N TATUM BLVD SUITE 1
PHOENIX AZ
85050-7500
US

IV. Provider business mailing address

26224 N TATUM BLVD SUITE 1
PHOENIX AZ
85050-7500
US

V. Phone/Fax

Practice location:
  • Phone: 480-563-1111
  • Fax: 480-563-3044
Mailing address:
  • Phone: 480-563-1111
  • Fax: 480-563-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27009
License Number StateAZ

VIII. Authorized Official

Name: MRS. DONNA R KNAPPER
Title or Position: MANAGER
Credential:
Phone: 480-563-1111