Healthcare Provider Details

I. General information

NPI: 1265573810
Provider Name (Legal Business Name): KATHERINE AZAR HAWORTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5056 N CENTRAL AVE
PHOENIX AZ
85012-1521
US

IV. Provider business mailing address

502 W LAS PALMARITAS DR
PHOENIX AZ
85021-5535
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-9111
  • Fax: 602-277-5111
Mailing address:
  • Phone: 602-222-9111
  • Fax: 602-277-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3152
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: