Healthcare Provider Details

I. General information

NPI: 1437709508
Provider Name (Legal Business Name): AZMO MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 WEST SUPERSTITION BOULEVARD # 101
APACHE JUNCTION AZ
85120
US

IV. Provider business mailing address

6262 E. BROWN RD STE 6
MESA AZ
85205
US

V. Phone/Fax

Practice location:
  • Phone: 480-612-8311
  • Fax:
Mailing address:
  • Phone: 480-528-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW B ONOFREI
Title or Position: OWNER
Credential:
Phone: 541-391-3636