Healthcare Provider Details

I. General information

NPI: 1225417348
Provider Name (Legal Business Name): ASSOCIATED RETINA CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E GLENDALE AVE
PHOENIX AZ
85020-5505
US

IV. Provider business mailing address

1750 E GLENDALE AVE
PHOENIX AZ
85020-5505
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-4928
  • Fax: 602-249-4813
Mailing address:
  • Phone: 602-242-4928
  • Fax: 602-249-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number
License Number State

VIII. Authorized Official

Name: PATTY BAEZA
Title or Position: HR DIRECTOR
Credential:
Phone: 602-242-4928