Healthcare Provider Details

I. General information

NPI: 1174453740
Provider Name (Legal Business Name): SPECTRUM PROVIDERS , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 N CENTRAL AVE STE 814
PHOENIX AZ
85004-1021
US

IV. Provider business mailing address

2828 N CENTRAL AVE STE 814
PHOENIX AZ
85004-1021
US

V. Phone/Fax

Practice location:
  • Phone: 818-723-7338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANN JAGENDA
Title or Position: MEMBER
Credential:
Phone: 818-723-7338