Healthcare Provider Details

I. General information

NPI: 1508815267
Provider Name (Legal Business Name): MICHELLE A ARMIJO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE A. POLLACK

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 N DYSART RD STE H131
AVONDALE AZ
85392-1003
US

IV. Provider business mailing address

3400 N DYSART RD STE H131
AVONDALE AZ
85392-1003
US

V. Phone/Fax

Practice location:
  • Phone: 623-535-9777
  • Fax: 623-236-3179
Mailing address:
  • Phone: 623-535-9777
  • Fax: 623-236-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2501
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2501
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: