Healthcare Provider Details

I. General information

NPI: 1851742860
Provider Name (Legal Business Name): AJLA S SINANOVIC RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15640 N 7TH ST STE 6
PHOENIX AZ
85022-3512
US

IV. Provider business mailing address

15640 N 7TH ST STE 6
PHOENIX AZ
85022-3512
US

V. Phone/Fax

Practice location:
  • Phone: 602-439-3800
  • Fax: 602-439-3802
Mailing address:
  • Phone: 602-439-3800
  • Fax: 602-439-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number009362
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: