Healthcare Provider Details

I. General information

NPI: 1104021088
Provider Name (Legal Business Name): IPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10835 N 25TH AVE STE 115
PHOENIX AZ
85029-3452
US

IV. Provider business mailing address

10835 N 25TH AVE STE 115
PHOENIX AZ
85029-3452
US

V. Phone/Fax

Practice location:
  • Phone: 480-517-4929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: MARIA RAQUEL SALDIVAR
Title or Position: STAFF PHYSICIAN
Credential: MD
Phone: 480-517-4929