| NPI | 1023834595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALAR KUPPAN Owner 623-261-5258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QP2300X Clinic/Center, Primary Care | |
| 363LA2100X Nurse Practitioner, Acute Care | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-11-29 |
| Last Update Date | 2025-01-13 |