Healthcare Provider Details

I. General information

NPI: 1871812131
Provider Name (Legal Business Name): MY SISTER MY FRIEND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 W SOUTHERN AVE
PHOENIX AZ
85041-4308
US

IV. Provider business mailing address

1325 W PIMA RD
PHOENIX AZ
85007-4142
US

V. Phone/Fax

Practice location:
  • Phone: 480-330-8468
  • Fax: 602-252-1371
Mailing address:
  • Phone: 602-252-1775
  • Fax: 602-252-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: MRS. ANN GLOVER
Title or Position: CEO
Credential:
Phone: 602-252-1775