Healthcare Provider Details

I. General information

NPI: 1033389911
Provider Name (Legal Business Name): GYNECOLGY CENTER OF PHOENIX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2222 E HIGHLAND AVE STE 225A
PHOENIX AZ
85016-4885
US

IV. Provider business mailing address

2222 E HIGHLAND AVE STE 225A
PHOENIX AZ
85016-4885
US

V. Phone/Fax

Practice location:
  • Phone: 602-234-1700
  • Fax:
Mailing address:
  • Phone: 602-234-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2692
License Number StateAZ

VIII. Authorized Official

Name: JACK OBADIA
Title or Position: OWNER
Credential: DO
Phone: 602-234-1700