Healthcare Provider Details

I. General information

NPI: 1972922755
Provider Name (Legal Business Name): HOLLY WEST D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N 16TH ST STE 202
PHOENIX AZ
85020-5265
US

IV. Provider business mailing address

7301 N 16TH ST STE 202
PHOENIX AZ
85020-5265
US

V. Phone/Fax

Practice location:
  • Phone: 602-753-2345
  • Fax: 602-419-3062
Mailing address:
  • Phone: 602-753-2345
  • Fax: 602-419-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number000779
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: