Healthcare Provider Details

I. General information

NPI: 1356467658
Provider Name (Legal Business Name): IATRIKO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E CHANDLER BLVD SUITE 304
PHOENIX AZ
85048-7643
US

IV. Provider business mailing address

4545 E CHANDLER BLVD SUITE 304
PHOENIX AZ
85048-7643
US

V. Phone/Fax

Practice location:
  • Phone: 480-961-2366
  • Fax: 480-961-2367
Mailing address:
  • Phone: 480-961-2366
  • Fax: 480-961-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CONSTANTINE SAFIS
Title or Position: PRESIDENT
Credential:
Phone: 480-961-2366