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NPI Code Detail

MEDICARE: HAVILAH CHELSEA DODD PA-C

MEDICARE: HAVILAH CHELSEA DODD PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramAZ
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1740809615
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAVILAH CHELSEA DODD PA-C
Provider Business Mailing Address
First Line : 14800 W MOUNTAIN VIEW BLVD STE 160
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-2700
Country : US
Telephone Number : 623-584-3376
Fax Number : 623-584-3375
Provider Business Practice Location Address
First Line : 14800 W MOUNTAIN VIEW BLVD STE 160
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-2700
Country : US
Telephone Number : 623-584-3376
Fax Number : 623-584-3375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2020
Last Update Date : 09/14/2021

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Directions to “ HAVILAH CHELSEA DODD PA-C” Practice Location

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