Healthcare Provider Details

I. General information

NPI: 1417644501
Provider Name (Legal Business Name): MARGOT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 E ARBOR AVE STE 106
MESA AZ
85206-6103
US

IV. Provider business mailing address

6116 E ARBOR AVE STE 106
MESA AZ
85206-6103
US

V. Phone/Fax

Practice location:
  • Phone: 480-636-7505
  • Fax:
Mailing address:
  • Phone: 480-636-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ERNESTO CLEMENTE HERNANDEZ
Title or Position: CEO
Credential:
Phone: 925-980-4935