Healthcare Provider Details

I. General information

NPI: 1780473108
Provider Name (Legal Business Name): MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14130 W MCDOWELL RD
GOODYEAR AZ
85395-2514
US

IV. Provider business mailing address

1645 E ROOSEVELT ST
PHOENIX AZ
85006-3638
US

V. Phone/Fax

Practice location:
  • Phone: 602-291-4414
  • Fax: 602-372-0342
Mailing address:
  • Phone: 602-291-4414
  • Fax: 602-372-0342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOEL KODICEK
Title or Position: SPECIALIZED SERVICES SUPERVISOR
Credential:
Phone: 480-662-5475