Healthcare Provider Details

I. General information

NPI: 1336354984
Provider Name (Legal Business Name): DESERT VALLEY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 N 108TH AVE
PHOENIX AZ
85037-5459
US

IV. Provider business mailing address

4137 N 108TH AVE
PHOENIX AZ
85037-5459
US

V. Phone/Fax

Practice location:
  • Phone: 623-877-7337
  • Fax:
Mailing address:
  • Phone: 623-877-7337
  • 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: KIM BRIGGS
Title or Position: ADMINISTRATOR
Credential:
Phone: 623-772-7842