Arizona Childrens Surgery PC

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

28876 Issued in AZ

Legal business name

ARIZONA CHILDRENS SURGERY PC

Practice address

1432 S Dobson Rd
Ste 301
Mesa, AZ 85202-4768

Phone

(480) 464-9400

Fax

(480) 464-9401

NPI assigned

Aug 18, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Enrique Ricardo Grisoni, MD

Title

Director

Phone

(480) 512-6514

Specialties & licenses 1

Addresses

Other names 1

• East Valley Pediatric Surgery Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184716800000",
    "number": "1104818822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41090",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852741090",
            "telephone_number": "480-464-9400",
            "fax_number": "480-464-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1432 S DOBSON RD",
            "address_2": "STE 301",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024768",
            "telephone_number": "480-464-9400",
            "fax_number": "480-464-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA CHILDRENS SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2007-07-18",
        "status": "A",
        "authorized_official_last_name": "GRISONI",
        "authorized_official_first_name": "ENRIQUE",
        "authorized_official_middle_name": "RICARDO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "480-512-6514",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": "AZ",
            "license": "28876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Valley Pediatric Surgery",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Pediatric Surgery Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pediatric Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.