Healthcare Provider Details

I. General information

NPI: 1205054855
Provider Name (Legal Business Name): DESERT NEONATOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 N 16TH ST STE 425
PHOENIX AZ
85020-4492
US

IV. Provider business mailing address

7720 N 16TH ST STE 425
PHOENIX AZ
85020-4492
US

V. Phone/Fax

Practice location:
  • Phone: 602-476-8962
  • Fax: 623-643-9236
Mailing address:
  • Phone: 602-476-8962
  • Fax: 623-643-9236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL COVEA MCQUEEN
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 602-476-8962