Healthcare Provider Details

I. General information

NPI: 1467914259
Provider Name (Legal Business Name): ADOBE ENT & ALLERGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE BLDG 7, STE 154
GLENDALE AZ
85308
US

IV. Provider business mailing address

20325 N 51ST AVE BLDG 7, STE 154
GLENDALE AZ
85308
US

V. Phone/Fax

Practice location:
  • Phone: 623-363-5480
  • Fax:
Mailing address:
  • Phone: 623-363-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL RODRIGUEZ
Title or Position: PRESIDENT
Credential: DO
Phone: 623-363-5480