Healthcare Provider Details

I. General information

NPI: 1144572900
Provider Name (Legal Business Name): JOAB LLITERAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4449 N 12TH ST SUITE A1
PHOENIX AZ
85014-4520
US

IV. Provider business mailing address

PO BOX 16906
PHOENIX AZ
85011-6906
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-1427
  • Fax: 602-279-1431
Mailing address:
  • Phone: 602-279-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4246645
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: