Healthcare Provider Details

I. General information

NPI: 1033543749
Provider Name (Legal Business Name): AKDHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10238 E HAMPTON AVE SUITE 504
MESA AZ
85209-3316
US

IV. Provider business mailing address

3003 N CENTRAL AVE SUITE 400
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 480-553-9277
  • Fax: 866-630-8347
Mailing address:
  • Phone: 602-351-3015
  • Fax: 602-224-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ADONIS ESCOBEDO
Title or Position: SENIOR CREDENTIALIST
Credential:
Phone: 602-351-3015