Healthcare Provider Details

I. General information

NPI: 1871546036
Provider Name (Legal Business Name): ESTRELLA PKWY MEDICAL CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N ESTRELLA PKWY STE. C-1
GOODYEAR AZ
85338-4137
US

IV. Provider business mailing address

530 N ESTRELLA PKWY STE. C-1
GOODYEAR AZ
85338-4137
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-9211
  • Fax: 623-932-9210
Mailing address:
  • Phone: 623-932-9211
  • Fax: 623-932-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3789
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP3364
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7681
License Number StateAZ

VIII. Authorized Official

Name: BRION DAVID MUSCARELLA
Title or Position: PRESIDENT
Credential:
Phone: 623-932-9211