Healthcare Provider Details

I. General information

NPI: 1508309626
Provider Name (Legal Business Name): VANGUARD MOBILE PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N PASADENA ST STE 3
GILBERT AZ
85233-5013
US

IV. Provider business mailing address

105 N PASADENA ST STE 3
GILBERT AZ
85233-5013
US

V. Phone/Fax

Practice location:
  • Phone: 480-246-3500
  • Fax: 480-246-3525
Mailing address:
  • Phone: 480-246-3500
  • Fax: 480-246-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. TARIK M SHIRIF
Title or Position: CEO, PRESIDENT
Credential:
Phone: 480-246-3593