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General NPI Number Information
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NPI Number | 1144390527
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Entity Type | Organization
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Legal Business Name | CHOLLA PEDIATRICS, PC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8333 N SILVERBELL RD STE 131
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City | TUCSON
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State | AZ
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Zip | 85743-7373
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Country | US
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Telephone | 520-382-1299
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Fax | 520-382-1298
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Provider Business Mailing Address
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Address Line | 2167 W ORANGE GROVE RD
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City | TUCSON
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State | AZ
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Zip | 85741-3118
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Country | US
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Telephone | 520-544-7650
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Fax | 520-544-7628
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | COURTNEY L DRUKE
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Credential | BSBA
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Telephone | 520-544-7650
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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 | 111592
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License Number State | AZ
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