Healthcare Provider Details

I. General information

NPI: 1689591380
Provider Name (Legal Business Name): FIGHT4 ME SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 N 19TH AVE STE 6
PHOENIX AZ
85029-3541
US

IV. Provider business mailing address

11801 N 19TH AVE STE 6
PHOENIX AZ
85029-3541
US

V. Phone/Fax

Practice location:
  • Phone: 480-468-1796
  • Fax:
Mailing address:
  • Phone: 480-468-1796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TAOFIK OTTUN
Title or Position: DIRECTOR
Credential:
Phone: 480-468-1796