Healthcare Provider Details

I. General information

NPI: 1225526536
Provider Name (Legal Business Name): DANIEL ANTHONY BOS AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W THUNDERBIRD RD
GLENDALE AZ
85306-4641
US

IV. Provider business mailing address

3438 E SEQUOIA DR
PHOENIX AZ
85050-3953
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-3777
  • Fax:
Mailing address:
  • Phone: 480-695-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: