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General NPI Number Information
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NPI Number | 1639760853
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Entity Type | Organization
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Legal Business Name | SUMMIT PEDIATRIC ANESTHESIA PLLC
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Dates
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Enumeration Date | 01/30/2021
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Last Update Date | 01/30/2021
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Provider Practice Location Address
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Address Line | 1920 E CAMBRIDGE AVE STE 100
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City | PHOENIX
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State | AZ
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Zip | 85006-1461
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Country | US
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Telephone | 602-933-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 2942 N 24TH ST STE 114
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City | PHOENIX
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State | AZ
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Zip | 85016-7849
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Country | US
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Telephone | 602-954-4575
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DAVID FUJII
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Credential |
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Telephone | 602-954-4575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number |
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License Number State |
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