| Organization Name: | SOUTHWESTERN PEDIATRICSPLLC |
| NPI Number: | 1093033110 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KELLIE ANN DENOS (FRONT OFFICE) |
| Mailing Address: | 21300 N John Wayne Pkwy Ste 109 Maricopa |
| State: | AZ US |
| Postal Code: | 851398964 |
| Phone Number: | 5205689500 |
| Fax Number: | 5205689533 |
| NPI Enumeration Date: | 05/13/2010 |
| NPI Last Update Date: | 05/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP3529 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |