Healthcare Provider Details

I. General information

NPI: 1962786228
Provider Name (Legal Business Name): MARICOPA COUNTY FORENSIC SCIENCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W JEFFERSON ST
PHOENIX AZ
85007-2908
US

IV. Provider business mailing address

701 W JEFFERSON ST
PHOENIX AZ
85007-2908
US

V. Phone/Fax

Practice location:
  • Phone: 602-506-3322
  • Fax: 602-506-1546
Mailing address:
  • Phone: 602-506-3322
  • Fax: 602-506-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number28529
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number28529
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN X HU
Title or Position: MEDICAL EXAMINER
Credential: MD
Phone: 602-506-3322