Healthcare Provider Details

I. General information

NPI: 1801905823
Provider Name (Legal Business Name): YOLANDA POOLEY PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20221 N 67TH AVE STE E3
GLENDALE AZ
85308-0602
US

IV. Provider business mailing address

20221 N 67TH AVE STE E3
GLENDALE AZ
85308-0602
US

V. Phone/Fax

Practice location:
  • Phone: 623-462-1981
  • Fax: 623-400-3348
Mailing address:
  • Phone: 623-462-1981
  • Fax: 623-400-3348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2229
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: