Healthcare Provider Details

I. General information

NPI: 1043999014
Provider Name (Legal Business Name): FELIZ FAMILY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 01/21/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 W GLENDALE AVE STE 32A
PHOENIX AZ
85051-8485
US

IV. Provider business mailing address

1345 E MAIN ST STE 100
MESA AZ
85203-8950
US

V. Phone/Fax

Practice location:
  • Phone: 602-246-7462
  • Fax:
Mailing address:
  • Phone: 480-264-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROMAN CARRASCO
Title or Position: CEO
Credential:
Phone: 480-264-3711