Provider Demographics
NPI:1023347150
Name:SOUTHWESTERN PEDIATRICS LLC
Entity type:Organization
Organization Name:SOUTHWESTERN PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:SULTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-568-9500
Mailing Address - Street 1:2730 S VAL VISTA DR
Mailing Address - Street 2:STE 161
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1675
Mailing Address - Country:US
Mailing Address - Phone:480-857-6316
Mailing Address - Fax:480-857-6638
Practice Address - Street 1:21300 N JOHN WAYNE PKWY
Practice Address - Street 2:STE 109
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8979
Practice Address - Country:US
Practice Address - Phone:520-568-9500
Practice Address - Fax:520-568-9533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWESTERN PEDIATRICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP3529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty