| NPI | 1609071646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZ MONTANO Credentialing Coordinator 480-784-1514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AZ BH-4062) |
| Additional Taxonomies | 251S00000X (Licence: AZ BH 373) |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2021-02-23 |