Healthcare Provider Details

I. General information

NPI: 1558439711
Provider Name (Legal Business Name): PASEO FAMILY PHYSICIANS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18275 N 59TH AVE SUITE K 162
GLENDALE AZ
85308-1260
US

IV. Provider business mailing address

18275 N 59TH AVE SUITE K 162
GLENDALE AZ
85308-1260
US

V. Phone/Fax

Practice location:
  • Phone: 602-547-8184
  • Fax: 602-547-8339
Mailing address:
  • Phone: 602-547-8184
  • Fax: 602-547-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARB ROBINS
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 602-547-8184