| NPI | 1346741501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE JENNETTE CORACIDES Member Manager 480-307-3497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 4462) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2018-07-09 |