Basic Information
| Provider Information | |||||||||
| NPI: | 1245703966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLEASANT PEDIATRICS PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9059 W LAKE PLEASANT PKWY STE E540 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853828396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233223380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15715 S 46TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804966444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2019 | ||||||||
| LastUpdateDate: | 01/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | RAVI | ||||||||
| AuthorizedOfficialFirstName: | PRASAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6233223380 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PLEASANT PEDIATRICS PLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.