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 |