Healthcare Provider Details

I. General information

NPI: 1013080928
Provider Name (Legal Business Name): CHOLLA PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2167 W ORANGE GROVE RD
TUCSON AZ
85741-3118
US

IV. Provider business mailing address

2167 W ORANGE GROVE RD
TUCSON AZ
85741-3118
US

V. Phone/Fax

Practice location:
  • Phone: 520-544-7650
  • Fax: 520-544-7628
Mailing address:
  • Phone: 520-544-7650
  • Fax: 520-544-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROBERT L PATTON
Title or Position: PRESIDENT
Credential: MD
Phone: 520-544-7650