Healthcare Provider Details

I. General information

NPI: 1962744722
Provider Name (Legal Business Name): AFC PHYSICAL MEDICINE OF DESERT RIDGE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20860 N TATUM BLVD SUITE 290
PHOENIX AZ
85050-4274
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: 480-563-1144
  • Fax:
Mailing address:
  • Phone: 310-474-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EUGENIA URSAN
Title or Position: MEDICAL DIRECTOR
Credential: NP
Phone: 480-563-1144