Healthcare Provider Details

I. General information

NPI: 1518959477
Provider Name (Legal Business Name): VLADIMIR TROCHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

17612 N 59TH AVE SUITE 100
GLENDALE AZ
85308-3795
US

IV. Provider business mailing address

17612 N 59TH AVE SUITE 100
GLENDALE AZ
85308-3795
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-8636
  • Fax: 602-993-2528
Mailing address:
  • Phone: 602-993-8636
  • Fax: 602-993-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number20010
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: