Healthcare Provider Details

I. General information

NPI: 1104004183
Provider Name (Legal Business Name): FOUNTAINS FAMILY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 S ALMA SCHOOL RD STE 1
CHANDLER AZ
85248-4510
US

IV. Provider business mailing address

3930 S ALMA SCHOOL RD STE 1
CHANDLER AZ
85248-4510
US

V. Phone/Fax

Practice location:
  • Phone: 480-726-6632
  • Fax: 480-726-3868
Mailing address:
  • Phone: 480-726-6632
  • Fax: 480-726-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD K LE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 480-726-6632