Healthcare Provider Details

I. General information

NPI: 1154740348
Provider Name (Legal Business Name): AFC OF PHOENIX, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N CENTRAL AVE SUITE 120
PHOENIX AZ
85004-2322
US

IV. Provider business mailing address

2980 N BEVERLY GLEN CIR SUITE 301
LOS ANGELES CA
90077-1726
US

V. Phone/Fax

Practice location:
  • Phone: 602-296-4060
  • Fax: 602-296-4146
Mailing address:
  • Phone: 310-943-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberAP5397
License Number StateAZ

VIII. Authorized Official

Name: LISA M. PACE
Title or Position: MEDICAL DIRECTOR
Credential: N.P.
Phone: 602-296-4060