Healthcare Provider Details

I. General information

NPI: 1013323591
Provider Name (Legal Business Name): PLEASANT PEDIATRICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12030 N 113TH AVE
YOUNGTOWN AZ
85363-1241
US

IV. Provider business mailing address

9059 W LAKE PLEASANT PKWY STE E540 SUITE E540
PEORIA AZ
85382-8396
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34320
License Number StateAZ

VIII. Authorized Official

Name: DR. SANDHYA RAVI
Title or Position: OWNER
Credential: MD
Phone: 623-322-3380