Healthcare Provider Details

I. General information

NPI: 1750157483
Provider Name (Legal Business Name): DAISY FAMILY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 W PEORIA AVE STE 115A
GLENDALE AZ
85302-2020
US

IV. Provider business mailing address

4494 W PEORIA AVE STE 115A
GLENDALE AZ
85302-2020
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-9737
  • Fax: 602-344-9737
Mailing address:
  • Phone: 602-344-9737
  • Fax: 602-344-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA DAVIS
Title or Position: PROVIDER
Credential: NP
Phone: 602-344-9737