Ponderosa Pediatricss Plc

NPI #1124243688 in Prescott, Arizona

Provider Information

NPI Number: 1124243688
Entity Type: Organization
Organization Name: Ponderosa Pediatricss Plc
Primary Specialty: Pediatrics
Enumeration Date: Apr 17, 2007
Last Updated: May 15, 2008

Practice Location

Address: 2120 CENTERPOINTE WEST DRIVE
City: Prescott
State: Arizona
ZIP Code: 86301
Phone: (928) 443-1111

Authorized Official

Name: DEANN HARGUESS
Title: CREDENTIALING BILLING
Phone: (928) 443-1111

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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