Healthcare Provider Details

I. General information

NPI: 1114863396
Provider Name (Legal Business Name): CLINICA DEL SOCORRO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E BELL RD STE 112
PHOENIX AZ
85022-6639
US

IV. Provider business mailing address

702 E BELL RD STE 112
PHOENIX AZ
85022-6639
US

V. Phone/Fax

Practice location:
  • Phone: 602-603-2282
  • Fax: 602-603-2283
Mailing address:
  • Phone: 602-603-2282
  • Fax: 602-603-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA S SULLIVAN
Title or Position: DIRECTOR
Credential: MD MPH
Phone: 480-248-5787