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 Not confirmed with CMS for 18 years — call before visiting
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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