NPI | 1730748435 |
---|---|
Entity Type | Organization |
Authorized Contact | CRYSTAL ALEJO Credentialing Supervisor 480-703-1883 |
Organization Subpart ? | No |
Primary Taxonomy | 103T00000X Psychologist |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
103TP2701X Psychologist, Group Psychotherapy | |
207R00000X Internal Medicine | |
207RG0300X Internal Medicine, Geriatric Medicine | |
261QM1300X Clinic/Center, Multi-Specialty | |
Enumeration Date | 2019-06-07 |
Last Update Date | 2019-09-04 |