Healthcare Provider Details

I. General information

NPI: 1952652893
Provider Name (Legal Business Name): PAX PEDIACTRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 E EDNA AVE SUITE 102
PHOENIX AZ
85032-2127
US

IV. Provider business mailing address

3933 E EDNA AVE SUITE 102
PHOENIX AZ
85032-2127
US

V. Phone/Fax

Practice location:
  • Phone: 602-569-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17503
License Number StateAZ

VIII. Authorized Official

Name: DR. DONNI FLEISCHAKER
Title or Position: DOCTOR/OWNER
Credential: M.D.
Phone: 602-569-5437