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General NPI Number Information
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NPI Number | 1073801056
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Entity Type | Organization
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Legal Business Name | ALL-STAR PEDIATRICS, PLLC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 4915 E BASELINE RD STE 119
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City | GILBERT
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State | AZ
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Zip | 85234-2965
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Country | US
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Telephone | 480-832-0480
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Fax |
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Provider Business Mailing Address
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Address Line | 4915 E BASELINE RD STE 119
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City | GILBERT
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State | AZ
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Zip | 85234-2969
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Country | US
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Telephone | 480-832-0480
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Fax | 480-832-0490
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVE MOUSSER
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Credential | M.D.
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Telephone | 480-832-0480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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