Healthcare Provider Details

I. General information

NPI: 1942248430
Provider Name (Legal Business Name): ADULT & PEDIATRIC ALLERGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 W BETHANY HOME RD 2
PHOENIX AZ
85015-1934
US

IV. Provider business mailing address

2236 W BETHANY HOME RD 2
PHOENIX AZ
85015-1934
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-4592
  • Fax: 602-242-9220
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TRACY ABNEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-242-4592