Healthcare Provider Details

I. General information

NPI: 1629076518
Provider Name (Legal Business Name): SCOTTSDALE PEDIATRICS AND PEDIATRIC NEPHROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/02/2025
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 E CHAUNCEY LN STE 225
PHOENIX AZ
85054-3117
US

IV. Provider business mailing address

7010 E CHAUNCEY LN STE 225
PHOENIX AZ
85054-3117
US

V. Phone/Fax

Practice location:
  • Phone: 480-585-5200
  • Fax: 480-585-5233
Mailing address:
  • Phone: 480-585-5200
  • Fax: 480-585-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33323
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number33323
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJEEV AGARWAL
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 480-585-5200