| 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 |