NPI 1255711131

Fiesta Pediatric Therapy

Organisation Early Intervention Provider Agency Phoenix, AZ

Practice location

Address: 2302 N 15th Ave, Phoenix, AZ 85007-1201
Phone: (602) 396-4374

Authorised official

Name: Vanessa Gaiser
Title: Speech Language Pathologist
Phone: (602) 396-4374

Registered specialties

Early Intervention Provider Agency Primary

Agencies Taxonomy 252Y00000X Licence TSLP9051 (AZ)

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Registry record

NPI: 1255711131
Entity type: Organization
NPI issued: 4 Jun 2015
Record last updated: 4 Jun 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.