Healthcare Provider Details

I. General information

NPI: 1649323551
Provider Name (Legal Business Name): PATRICIA ANN CREMONA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85338-2618
US

IV. Provider business mailing address

PO BOX 708850
SANDY UT
84070-8850
US

V. Phone/Fax

Practice location:
  • Phone: 602-568-1599
  • Fax:
Mailing address:
  • Phone: 866-869-2395
  • Fax: 801-352-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number44034
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21864
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: