Healthcare Provider Details

I. General information

NPI: 1669358552
Provider Name (Legal Business Name): HONORHEALTH AMBULATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5133 N CENTRAL AVE STE 206
PHOENIX AZ
85012-1438
US

IV. Provider business mailing address

2500 W UTOPIA RD
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 623-580-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN NEIL
Title or Position: CMO
Credential:
Phone: 480-587-5123