Healthcare Provider Details

I. General information

NPI: 1275651507
Provider Name (Legal Business Name): ALEX J ONOFREI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 E BROWN RD
MESA AZ
85205-4960
US

IV. Provider business mailing address

6130 E BROWN RD
MESA AZ
85205-4960
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-3554
  • Fax: 480-807-8330
Mailing address:
  • Phone: 480-807-3554
  • Fax: 480-807-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number24575
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26832
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24575
License Number StateAZ

VIII. Authorized Official

Name: DESIREE OGLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-807-3554