Healthcare Provider Details

I. General information

NPI: 1215275433
Provider Name (Legal Business Name): EMERGENCY GROUP OF ARIZONA PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BETHANY HOME RD
PHOENIX AZ
85015-2443
US

IV. Provider business mailing address

4637 CHABOT DR STE 104
PLEASANTON CA
94588-2749
US

V. Phone/Fax

Practice location:
  • Phone: 925-924-1600
  • Fax:
Mailing address:
  • Phone: 925-924-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBIN MOUGANIS
Title or Position: DIRECTOR PROVIDER ENROLLMENT
Credential:
Phone: 856-686-4394