Organization
FIESTA PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS VANESSA GAISER CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(602) 396-4374
Entity
Organization
Contact information
Practice address
2302 N 15TH AVE, PHOENIX, AZ 85007-1201
(602) 396-4374
Mailing address
2302 N 15TH AVE, PHOENIX, AZ 85007-1201
(602) 396-4374
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
TSLP9051
AZ
Other
Enumeration date
06/04/2015
Last updated
06/04/2015
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