Healthcare Provider Details

I. General information

NPI: 1013250018
Provider Name (Legal Business Name): THE CLINICAL INFUSION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S LINDSAY RD SUITE 123
GILBERT AZ
85297-1503
US

IV. Provider business mailing address

2121 S MILL AVE
TEMPE AZ
85282-2138
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-9939
  • Fax: 480-821-9555
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number29620
License Number StateAZ

VIII. Authorized Official

Name: DR. TOCHUKWU NWAFOR
Title or Position: MD
Credential:
Phone: 480-821-9339