Provider Demographics
NPI:1588992820
Name:ERNESTA PEARL
Entity type:Organization
Organization Name:ERNESTA PEARL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSEE
Authorized Official - Prefix:MS
Authorized Official - First Name:ERNESTA
Authorized Official - Middle Name:DAUZ
Authorized Official - Last Name:PEARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-295-9214
Mailing Address - Street 1:13614 N 89TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7653
Mailing Address - Country:US
Mailing Address - Phone:602-295-9214
Mailing Address - Fax:480-219-1607
Practice Address - Street 1:2836 S 94TH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-1412
Practice Address - Country:US
Practice Address - Phone:602-295-9214
Practice Address - Fax:480-219-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3308261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service