NPI | 1255976403 |
---|---|
Doing Business As | RADIANT ADULT MEDICAL GROUP |
Entity Type | Organization |
Authorized Contact | JENNIVYR DERAKHSHAN President 928-483-9911 |
Organization Subpart ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
Enumeration Date | 2019-11-12 |
Last Update Date | 2024-09-13 |