Healthcare Provider Details

I. General information

NPI: 1265037485
Provider Name (Legal Business Name): CLINICAL ASSOCIATES OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 W OLIVE AVE STE 102
GLENDALE AZ
85302-3147
US

IV. Provider business mailing address

PO BOX 417
PEORIA AZ
85380-0417
US

V. Phone/Fax

Practice location:
  • Phone: 480-438-5529
  • Fax:
Mailing address:
  • Phone: 480-438-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATRINA SPRADLING
Title or Position: CO-OWNER
Credential: FNP-C
Phone: 623-208-0589