Healthcare Provider Details

I. General information

NPI: 1841032992
Provider Name (Legal Business Name): ADOBE MEDICAL GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 E ADOBE ST STE 200
MESA AZ
85213-6740
US

IV. Provider business mailing address

2017 E ADOBE ST STE 200
MESA AZ
85213-6740
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-0241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MIKAEL PAYAN
Title or Position: PRESIDENT/DIRECTOR
Credential:
Phone: 480-269-0241