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General NPI Number Information
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NPI Number | 1043422777
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Entity Type | Individual
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Provider Name | DESIREE DAWN BROTSKY D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 15396 N 83RD AVE STE F100
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City | PEORIA
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State | AZ
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Zip | 85381
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Country | US
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Telephone | 602-595-9696
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Fax | 602-412-9123
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Provider Business Mailing Address
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Address Line | PO BOX 10967
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City | GLENDALE
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State | AZ
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Zip | 85318-0967
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Country | US
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Telephone | 602-595-9696
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Fax | 623-412-9123
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 005718
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License Number State | AZ
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