Healthcare Provider Details

I. General information

NPI: 1639627789
Provider Name (Legal Business Name): PLEASANT PEDIATRICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2932 N 14TH ST
PHOENIX AZ
85014-5601
US

IV. Provider business mailing address

9059 W LAKE PLEASANT PKWY SUITE E540
PEORIA AZ
85382-8336
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-3380
  • Fax: 623-322-4399
Mailing address:
  • Phone: 623-322-3380
  • Fax: 623-322-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PRASAD RAVI
Title or Position: OWNER/PRACTICE MANAGER
Credential:
Phone: 623-234-3242