Healthcare Provider Details

I. General information

NPI: 1760660815
Provider Name (Legal Business Name): SOUTHWEST INTERNAL MEDICINE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6242 E ARBOR AVE STE 106
MESA AZ
85206-1309
US

IV. Provider business mailing address

6242 E ARBOR AVE STE 106
MESA AZ
85206-1309
US

V. Phone/Fax

Practice location:
  • Phone: 480-889-2165
  • Fax: 480-889-2164
Mailing address:
  • Phone: 480-889-2165
  • Fax: 480-889-2164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22263
License Number StateAZ

VIII. Authorized Official

Name: DR. MONICA ABRANTE
Title or Position: PHYSICIAN
Credential: M.D
Phone: 480-889-2165