Healthcare Provider Details

I. General information

NPI: 1023354677
Provider Name (Legal Business Name): LOTUS TRANSITIONAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9570 W QUAIL AVE
PEORIA AZ
85382-0562
US

IV. Provider business mailing address

19801 N 59TH AVE #11424
GLENDALE AZ
85318-5001
US

V. Phone/Fax

Practice location:
  • Phone: 602-920-1817
  • Fax: 623-243-9945
Mailing address:
  • Phone: 602-920-1817
  • Fax: 623-243-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number5032
License Number StateAZ

VIII. Authorized Official

Name: CHRISTINE M. ESTRADA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 602-920-1817