| NPI | 1295506590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOVEJOY TULUSAN ARRIESGADO Nurse Practitioner 602-888-2677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QI0500X Clinic/Center Infusion Therapy |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QM2500X Clinic/Center Medical Specialty | |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2024-01-15 |