Healthcare Provider Details

I. General information

NPI: 1134942857
Provider Name (Legal Business Name): ASSURED PEDIATRICS ARIZONA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 E DESERT BROOM WAY
PHOENIX AZ
85044-8722
US

IV. Provider business mailing address

3202 E DESERT BROOM WAY
PHOENIX AZ
85044-8722
US

V. Phone/Fax

Practice location:
  • Phone: 707-338-8636
  • Fax:
Mailing address:
  • Phone: 707-338-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON MERRICK
Title or Position: MEMBER
Credential:
Phone: 707-338-8636