MEDICARE: DESERT VIEW MEDICAL CENTER AND PEDIATRICS, CORP

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	207N00000X	Dermatology Physician
2	207Q00000X	Family Medicine Physician

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	:	1790183564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT VIEW MEDICAL CENTER AND PEDIATRICS, CORP

Provider Business Mailing Address
First Line	:	727 E BETHANY HOME RD STE B112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2151
Country	:	US
Telephone Number	:	602-279-2400
Fax Number	:	602-279-5890

Provider Business Practice Location Address
First Line	:	3201 W PEORIA AVE STE D805
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4600
Country	:	US
Telephone Number	:	602-279-2400
Fax Number	:	602-279-5890

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MRS. MIRTA C DALOTTO
Credential	:
Telephone Number	:	602-569-5437

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	02/21/2025

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