Healthcare Provider Details

I. General information

NPI: 1346284668
Provider Name (Legal Business Name): ABRAHAM OWUSU-DOMMEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 2510
MESA AZ
85214-2510
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-9339
  • Fax: 480-821-9555
Mailing address:
  • Phone: 480-821-9339
  • Fax: 480-821-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number26852
License Number StateAZ

VIII. Authorized Official

Name: DR. ABRAHAM OWUSU DOMMEY
Title or Position: OWNER
Credential: M.D.
Phone: 480-821-9339