Healthcare Provider Details

I. General information

NPI: 1073783874
Provider Name (Legal Business Name): DESERT INSTITUTE OF CLASSICAL HOMEOPATHY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W CAMELBACK RD STE 150
PHOENIX AZ
85015-7402
US

IV. Provider business mailing address

2001 W CAMELBACK RD STE 150
PHOENIX AZ
85015-7402
US

V. Phone/Fax

Practice location:
  • Phone: 602-347-7950
  • Fax:
Mailing address:
  • Phone: 602-347-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number67
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20811
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3013
License Number StateAZ

VIII. Authorized Official

Name: MARY PATTERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-347-7950