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General NPI Number Information
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NPI Number | 1710139860
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Entity Type | Organization
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Legal Business Name | SONORAN SKY PEDIATRICS
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 10720 E SOUTHERN AVE SUITE 116
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City | MESA
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State | AZ
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Zip | 85209-3810
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Country | US
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Telephone | 480-365-0050
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Fax | 480-365-0049
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Provider Business Mailing Address
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Address Line | 10720 E SOUTHERN AVE SUITE 116
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City | MESA
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State | AZ
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Zip | 85209-3810
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Country | US
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Telephone | 480-365-0050
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Fax | 480-365-0049
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Authorized Official
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Title or Position | OWNER
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Name | RUTH E LETIZIA
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Credential | M.D.
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Telephone | 480-365-0050
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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 | AZ
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