| NPI | 1508310665 |
|---|---|
| Former Legal Business Name | MEDICAL MALL OF ARIZONA FAMILY PRACTICE PLLC |
| Entity Type | Organization |
| Authorized Contact | STACY DEANN VELDHUIZEN MICKEY Md/Owner 480-999-0049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2022-12-14 |