Healthcare Provider Details

I. General information

NPI: 1689252504
Provider Name (Legal Business Name): MOMSULTANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 N TATUM BLVD STE 102848
PHOENIX AZ
85028-6055
US

IV. Provider business mailing address

10810 N TATUM BLVD STE 102848
PHOENIX AZ
85028-6055
US

V. Phone/Fax

Practice location:
  • Phone: 520-428-4262
  • Fax: 480-248-8292
Mailing address:
  • Phone: 520-428-4262
  • Fax: 480-248-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: ASHLYN O'BRIEN
Title or Position: CEO
Credential:
Phone: 520-428-4262