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General NPI Number Information
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NPI Number | 1578700852
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Entity Type | Organization
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Legal Business Name | NORTH VALLEY PEDIATRICS PC
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 14045 N 7TH ST STE 2
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City | PHOENIX
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State | AZ
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Zip | 85022-4387
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Country | US
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Telephone | 602-482-7311
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Fax | 602-482-7314
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Provider Business Mailing Address
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Address Line | 14045 N 7TH ST STE 2
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City | PHOENIX
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State | AZ
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Zip | 85022-4387
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Country | US
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Telephone | 602-482-7311
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Fax | 602-482-7314
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DR. JOANN KOLNICK
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Credential | M.D.
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Telephone | 602-290-7190
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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 | 19585
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License Number State | AZ
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