Organization
EAST MESA PEDIATRICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOJASTEH M GHAZIASKAR MD (OWNER)
(480) 396-2087
Entity
Organization
Contact information
Practice address
6142 E BROWN RD, #102, MESA, AZ 85205-4962
(480) 396-2087
(480) 396-3973
Mailing address
6142 E BROWN RD, #102, MESA, AZ 85205-4962
(480) 396-2087
(480) 396-3973
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
34309
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
964149
—
AZ
Enumeration date
12/26/2007
Last updated
07/27/2010
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