Healthcare Provider Details

I. General information

NPI: 1578700852
Provider Name (Legal Business Name): NORTH VALLEY PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14045 N 7TH ST STE 2
PHOENIX AZ
85022-4387
US

IV. Provider business mailing address

14045 N 7TH ST STE 2
PHOENIX AZ
85022-4387
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-7311
  • Fax: 602-482-7314
Mailing address:
  • Phone: 602-482-7311
  • Fax: 602-482-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19585
License Number StateAZ

VIII. Authorized Official

Name: DR. JOANN KOLNICK
Title or Position: PRACTICE ADMINISTRATOR
Credential: M.D.
Phone: 602-290-7190