Healthcare Provider Details

I. General information

NPI: 1013466192
Provider Name (Legal Business Name): TERNION PHYSICIAN GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42104 N VENTURE DR SUITE D118
ANTHEM AZ
85086-3823
US

IV. Provider business mailing address

42104 N VENTURE DR SUITE D118
ANTHEM AZ
85086-3823
US

V. Phone/Fax

Practice location:
  • Phone: 623-505-9880
  • Fax: 623-505-9880
Mailing address:
  • Phone: 623-505-9880
  • Fax: 623-505-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LILIANA PEREZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 623-505-9880