Healthcare Provider Details

I. General information

NPI: 1467415331
Provider Name (Legal Business Name): BRAD A FIORITO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

PO BOX 27340
PHOENIX AZ
85061-7340
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3000
  • Fax:
Mailing address:
  • Phone: 602-943-9200
  • Fax: 602-216-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4103
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number4103
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: