Healthcare Provider Details

I. General information

NPI: 1891383675
Provider Name (Legal Business Name): MR. OSCAR NOE YEPIZ RIOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 W MELINDA LN
GLENDALE AZ
85308-9591
US

IV. Provider business mailing address

6950 W MELINDA LN
GLENDALE AZ
85308-9591
US

V. Phone/Fax

Practice location:
  • Phone: 602-334-0688
  • Fax:
Mailing address:
  • Phone: 602-334-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW22446
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: