Healthcare Provider Details

I. General information

NPI: 1417204157
Provider Name (Legal Business Name): MARICOPA COUNTY DBA MARICOPA COUNTY OF PUBLIC HEALTH SERVICES DBA PUBL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 E ROOSEVELT STREET
PHOENIX AZ
85006
US

IV. Provider business mailing address

1645 E. ROOSEVELT STREET
PHOENIX AZ
85006
US

V. Phone/Fax

Practice location:
  • Phone: 602-506-6997
  • Fax: 602-372-0342
Mailing address:
  • Phone: 602-506-6997
  • Fax: 602-372-0342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberAZ016
License Number StateAZ

VIII. Authorized Official

Name: CORINNE VELASQUEZ
Title or Position: CLINICAL ADMINISTRATOR
Credential:
Phone: 602-506-6657