Healthcare Provider Details

I. General information

NPI: 1831076686
Provider Name (Legal Business Name): FREEDOM MEDICAL DIAGNOSTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5551 W CALAVAR RD
GLENDALE AZ
85306-4605
US

IV. Provider business mailing address

5551 W CALAVAR RD
GLENDALE AZ
85306-4605
US

V. Phone/Fax

Practice location:
  • Phone: 623-262-5824
  • Fax:
Mailing address:
  • Phone: 623-262-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JENNIFER ELIZABETH MALOY
Title or Position: FOUNDER /OWNER
Credential:
Phone: 623-262-5824