Healthcare Provider Details

I. General information

NPI: 1922762699
Provider Name (Legal Business Name): ARIZONA ASTHMA ALLERGY LEGACY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13965 N 75TH AVE
PEORIA AZ
85381-6097
US

IV. Provider business mailing address

13965 N 75TH AVE
PEORIA AZ
85381-6097
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-2991
  • Fax:
Mailing address:
  • Phone: 602-843-2991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD MCGEE
Title or Position: CFO
Credential:
Phone: 602-843-2991