Healthcare Provider Details

I. General information

NPI: 1265349294
Provider Name (Legal Business Name): MY HOME DOC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 E NORTHERN AVE STE 100
PHOENIX AZ
85020-3953
US

IV. Provider business mailing address

1825 E NORTHERN AVE STE 100
PHOENIX AZ
85020-3953
US

V. Phone/Fax

Practice location:
  • Phone: 480-992-9834
  • Fax: 480-956-8202
Mailing address:
  • Phone: 480-992-9834
  • Fax: 480-956-8202

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: NILESH PATEL
Title or Position: CEO
Credential: MD
Phone: 602-469-9466