Healthcare Provider Details

I. General information

NPI: 1427381235
Provider Name (Legal Business Name): BRYAN DARVELL SANFORD J.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12567 W MAZATZAL DR
PEORIA AZ
85383-0380
US

IV. Provider business mailing address

12567 W MAZATZAL DR
PEORIA AZ
85383-0380
US

V. Phone/Fax

Practice location:
  • Phone: 702-578-6779
  • Fax:
Mailing address:
  • Phone: 702-578-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: