Healthcare Provider Details

I. General information

NPI: 1619734126
Provider Name (Legal Business Name): JULIUS NDAHIRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 S 15TH DR
PHOENIX AZ
85041-6932
US

IV. Provider business mailing address

7321 S 15TH DR
PHOENIX AZ
85041-6932
US

V. Phone/Fax

Practice location:
  • Phone: 443-739-9197
  • Fax:
Mailing address:
  • Phone: 443-739-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number21416089
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: