Organization
PONDEROSA PEDIATRICSS PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANN HARGUESS (CREDENTIALING BILLING)
(928) 443-1111
Entity
Organization
Contact information
Practice address
2120 CENTERPOINTE WEST DRIVE, PRESCOTT, AZ 86301
(928) 443-1111
(928) 443-5554
Mailing address
2120 CENTERPOINTE WEST DRIVE, PRESCOTT, AZ 86301
(928) 443-1111
(928) 443-5554
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144299090
INDIVIDUAL NPI
AZ
01
—
1144299678
INDIVIDUAL NPI
AZ
01
—
1326169657
INDIVIDUAL NPI
AZ
01
—
1336118926
INDIVIDUAL NPI
AZ
01
—
1629047097
INDIVIDUAL NPI
AZ
01
—
1881653558
INDIVIDUAL NPI
AZ
01
—
1912976879
INDIVIDUAL NPI
AZ
Enumeration date
04/17/2007
Last updated
05/15/2008
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