Dessalines Sports Medicine, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

DESSALINES SPORTS MEDICINE, LLC

Practice address

6424 E Broadway Rd Ste 102
Mesa, AZ 85206-1750

Phone

(480) 634-4606

NPI assigned

Oct 4, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Charles Peterson, MD

Title

Doctor

Phone

(480) 634-4606

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538611200000",
    "number": "1407321581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6424 E BROADWAY RD STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061750",
            "telephone_number": "480-634-4606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6424 E BROADWAY RD STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061750",
            "telephone_number": "480-634-4606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESSALINES SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-04",
        "last_updated": "2018-10-04",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "480-634-4606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori P. Desmond, MS CCC-SLP
• Adam Desnous
• Holly Christine Desouza, RN
• Samuel Kobina Desouza Jr., PA-C
• Samantha Desruisseaux, APRN-RNP
• Amanda M Destefano-Marks
• Destination Assisted Living Home LLC
• Rachel Renee Desvergnes
• Jessica Dettra, P.A.
• Florence Wairimu Deuel, PMHNP-BC

• Clinic/Center in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; 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.