Healthcare Provider Details

I. General information

NPI: 1588721823
Provider Name (Legal Business Name): ARIZONA INSTITUTE OF NEUROPSYCIATRIC DISORDERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 E BEVERLY AVE SUITE 106
KINGMAN AZ
86409-3593
US

IV. Provider business mailing address

1739 E BEVERLY AVE SUITE 106
KINGMAN AZ
86409-3593
US

V. Phone/Fax

Practice location:
  • Phone: 928-692-5200
  • Fax: 928-692-5252
Mailing address:
  • Phone: 928-692-5200
  • Fax: 928-692-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: RAYMOND A MONDORA
Title or Position: OWNER
Credential: D.O.
Phone: 928-692-5200