| NPI | 1245648088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANA KHATIB Provider 602-339-3669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 42064) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5212) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2014-07-24 |