Organization
PEBBLE CREEK MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANJAY BOMMAKANTI MD (MD/OWNER)
(623) 337-6897
Entity
Organization
Contact information
Practice address
700 N ESTRELLA PKWY # 130, GOODYEAR, AZ 85338-9271
(623) 322-2144
(623) 322-1165
Mailing address
18210 N ORGAN PIPE DR, SUN CITY, AZ 85373-1757
(602) 410-6951
(480) 304-3234
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
37252
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281108
—
AZ
Enumeration date
05/31/2017
Last updated
05/31/2017
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