Healthcare Provider Details

I. General information

NPI: 1952748816
Provider Name (Legal Business Name): COMMUNITY ASSET & RESOURCE ENTERPRISE PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 S BELLVIEW
MESA AZ
85204-2502
US

IV. Provider business mailing address

466 S BELLVIEW
MESA AZ
85204-2502
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-5197
  • Fax: 480-833-8842
Mailing address:
  • Phone: 480-962-5197
  • Fax: 480-833-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. BEV TITTLE-BAKER
Title or Position: PRES/CEO
Credential:
Phone: 480-962-5197