Healthcare Provider Details

I. General information

NPI: 1083524433
Provider Name (Legal Business Name): CASA DEL FENIX PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48739 N 5TH AVE
NEW RIVER AZ
85087-8581
US

IV. Provider business mailing address

4539 N 22ND ST STE N
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 602-456-5607
  • Fax:
Mailing address:
  • Phone: 602-456-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LEO O MERINO
Title or Position: OWNER
Credential: MA, LPC
Phone: 602-456-5607