Healthcare Provider Details

I. General information

NPI: 1235516105
Provider Name (Legal Business Name): ELIZABETH VICTORIA FREAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 S 98TH PL
MESA AZ
85208-2578
US

IV. Provider business mailing address

138 S TEMPLE ST
MESA AZ
85204-1125
US

V. Phone/Fax

Practice location:
  • Phone: 480-380-9923
  • Fax:
Mailing address:
  • Phone: 480-455-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: