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General NPI Number Information
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NPI Number | 1063138196
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Entity Type | Organization
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Legal Business Name | SOUTHWEST PEDIATRICS PAYMENT PROCESSING, LLC
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 3201 W PEORIA AVE STE A205
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City | PHOENIX
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State | AZ
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Zip | 85029-4608
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Country | US
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Telephone | 602-568-5753
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Fax |
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Provider Business Mailing Address
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Address Line | 1753 E BROADWAY RD STE 101-307
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City | TEMPE
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State | AZ
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Zip | 85282-1585
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MARITZA IRIZARRY
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Credential |
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Telephone | 480-686-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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