Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ponderosa Pediatricss PLC

Organization Pediatrics Physician · NPI 1124243688

Ponderosa Pediatricss PLC is a Pediatrics Physician in Prescott, Arizona. Registered with an NPI since 2007.

In the registry since
2007

Practice location Address checks out

2120 Centerpointe West Dr
Prescott, AZ 86301
Phone: (928) 443-1111
Fax: (928) 443-5554
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X

Record details

NPI number1124243688
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Deann Harguess — Credentialing Billing · (928) 443-1111
NPI enumeratedApril 17, 2007
Last updated in NPPESMay 15, 2008
Mailing address2120 Centerpointe West Drive, Prescott, AZ 86301

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