Healthcare Provider Details

I. General information

NPI: 1801924972
Provider Name (Legal Business Name): DAVID JEWETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 W THUNDERBIRD RD
GLENDALE AZ
85306-4002
US

IV. Provider business mailing address

12922 W LA VINA DR
SUN CITY WEST AZ
85375-2674
US

V. Phone/Fax

Practice location:
  • Phone: 623-486-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3622575
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: