Healthcare Provider Details

I. General information

NPI: 1568783314
Provider Name (Legal Business Name): TRITIA MARIA PUSATERI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRITIA MARIA DESA MD

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 WEST THOMAS ROAD
PHOENIX AZ
85033-5700
US

IV. Provider business mailing address

2702 N. 3RD STREET SUITE 4020
PHOENIX AZ
85004-4608
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 602-247-9742
Mailing address:
  • Phone: 602-243-7277
  • Fax: 602-323-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49269
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: