Healthcare Provider Details

I. General information

NPI: 1508036377
Provider Name (Legal Business Name): ARIZONA ENDOCRINOLOGY CENTER, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15640 N 28TH DR
PHOENIX AZ
85053-4059
US

IV. Provider business mailing address

15640 N 28TH DR
PHOENIX AZ
85053-4059
US

V. Phone/Fax

Practice location:
  • Phone: 602-439-9000
  • Fax: 602-978-5233
Mailing address:
  • Phone: 602-439-9000
  • Fax: 602-978-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number0931-5024
License Number StateAZ

VIII. Authorized Official

Name: DR. CHET SINGH MONDER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-439-9000