Healthcare Provider Details

I. General information

NPI: 1043915721
Provider Name (Legal Business Name): MEGAN ANN DESTEFANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ANN RIFFLE

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

290 E INDIGO DR
CHANDLER AZ
85286-1643
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5095
  • Fax:
Mailing address:
  • Phone: 480-330-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number012657
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: