Healthcare Provider Details

I. General information

NPI: 1154363547
Provider Name (Legal Business Name): ARIZONA ENDOCRINOLOGY CENTER, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/26/2014
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: 602-439-9623
  • Fax: 602-978-5233
Mailing address:
  • Phone: 602-439-9623
  • Fax: 602-978-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAZ

VIII. Authorized Official

Name: MRS. GURBAKSH KAUR SANDHU
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-439-9623