Healthcare Provider Details

I. General information

NPI: 1770471849
Provider Name (Legal Business Name): ADELA BJELOBRKOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W TALAVI BLVD
GLENDALE AZ
85306-1886
US

IV. Provider business mailing address

3216 W LANGUID LN
PHOENIX AZ
85086-2229
US

V. Phone/Fax

Practice location:
  • Phone: 602-671-2506
  • Fax:
Mailing address:
  • Phone: 602-515-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: