Healthcare Provider Details

I. General information

NPI: 1972058725
Provider Name (Legal Business Name): DELTA T
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 N DREAMY DRAW DR SUITE250
PHOENIX AZ
85020-4660
US

IV. Provider business mailing address

16485 N STADIUM WAY UNIT 3024
SURPRISE AZ
85374-4391
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-5051
  • Fax:
Mailing address:
  • Phone: 623-999-4419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberLP9666022
License Number StateAZ

VIII. Authorized Official

Name: MRS. JEAN ELLEN MAURER
Title or Position: LPN
Credential:
Phone: 623-999-4410