Healthcare Provider Details

I. General information

NPI: 1184497778
Provider Name (Legal Business Name): FELIZ FAMILY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 01/21/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 N 67TH AVE
GLENDALE AZ
85301-6541
US

IV. Provider business mailing address

1345 E MAIN ST STE 100
MESA AZ
85203-8950
US

V. Phone/Fax

Practice location:
  • Phone: 602-773-1234
  • Fax:
Mailing address:
  • Phone: 480-264-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROMAN CARRASCO
Title or Position: DIRECTOR
Credential:
Phone: 480-404-7158