Organization
VALLEY OF THE SUN PEDIATRICS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ED MATROSE (OFFICE MANAGER)
(623) 362-1818
Entity
Organization
Contact information
Practice address
10200 W HAPPY VALLEY RD, STE 125, PEORIA, AZ 85383-2878
(623) 362-1818
(623) 362-8095
Mailing address
10200 W HAPPY VALLEY RD, STE 125, PEORIA, AZ 85383-2878
(623) 362-1818
(623) 362-8095
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
33560
AZ
363LP0200X
Pediatric Nurse Practitioner
AP3855
AZ
363LP0200X
Pediatric Nurse Practitioner
AP4013
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
595173
—
AZ
05
—
645390
—
AZ
05
—
933780
—
AZ
Enumeration date
03/23/2012
Last updated
03/23/2012
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