Organization Name: | SOUTHWESTERN PEDIATRICS LLC |
NPI Number: | 1023347150 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SULTAN AYOUB (FAMILY NURSE PRACTIONER) |
Mailing Address: | 21300 N John Wayne Pkwy Ste 109 Maricopa |
State: | AZ US |
Postal Code: | 851398979 |
Phone Number: | 5205689500 |
Fax Number: | 5205689533 |
NPI Enumeration Date: | 12/21/2009 |
NPI Last Update Date: | 12/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | TAP3529 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |