Healthcare Provider Details

I. General information

NPI: 1740888684
Provider Name (Legal Business Name): RESOURCEFUL MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 E BROADWAY RD STE 102
MESA AZ
85206-1750
US

IV. Provider business mailing address

6424 E BROADWAY RD STE 102
MESA AZ
85206-1750
US

V. Phone/Fax

Practice location:
  • Phone: 480-634-4606
  • Fax:
Mailing address:
  • Phone: 480-634-4606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDIE HERNANDEZ
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 480-634-4606