Healthcare Provider Details

I. General information

NPI: 1447458682
Provider Name (Legal Business Name): VO OF ARIZONA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 W CAMELBACK RD
GLENDALE AZ
85301-7505
US

IV. Provider business mailing address

5342 W CAMELBACK RD
GLENDALE AZ
85301-7505
US

V. Phone/Fax

Practice location:
  • Phone: 623-842-3404
  • Fax:
Mailing address:
  • Phone: 623-842-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. ANGELO EDGE
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 602-685-3846