MEDICARE: PLEASANT PEDIATRICS PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	34320	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356859128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT PEDIATRICS PLC

Provider Business Mailing Address
First Line	:	9059 W LAKE PLEASANT PKWY STE E540
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-8396
Country	:	US
Telephone Number	:	623-322-3380
Fax Number	:

Provider Business Practice Location Address
First Line	:	10180 W HAPPY VALLEY PKWY STE 100
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1389
Country	:	US
Telephone Number	:	623-322-3380
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	PRASAD RAVI
Credential	:
Telephone Number	:	623-322-3380

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	10/29/2022

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Directions to “PLEASANT PEDIATRICS PLC ” Practice Location

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