Healthcare Provider Details

I. General information

NPI: 1316612146
Provider Name (Legal Business Name): TRI CITY ENDOCRINOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S DOBSON RD STE 218
MESA AZ
85202-4754
US

IV. Provider business mailing address

1520 S DOBSON RD STE 218
MESA AZ
85202-4754
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-8737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MANAL ALHAKIM
Title or Position: MEMBER MANAGER
Credential: MD
Phone: 480-626-8737