Healthcare Provider Details

I. General information

NPI: 1629241807
Provider Name (Legal Business Name): ARIZONA VULVA CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE STE 100 300 W. CLARENDON, #100
PHOENIX AZ
85013-3421
US

IV. Provider business mailing address

300 W CLARENDON AVE STE 100 300 W. CLARENDON, #100
PHOENIX AZ
85013-3421
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-1112
  • Fax: 602-264-4101
Mailing address:
  • Phone: 602-265-1112
  • Fax: 602-264-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH A.D. BROOKS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 602-265-1112