Healthcare Provider Details

I. General information

NPI: 1699581306
Provider Name (Legal Business Name): SAFIYA KALIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N CENTRAL AVE STE 105
PHOENIX AZ
85004-4416
US

IV. Provider business mailing address

1 N CENTRAL AVE STE 105
PHOENIX AZ
85004-4416
US

V. Phone/Fax

Practice location:
  • Phone: 602-255-7650
  • Fax:
Mailing address:
  • Phone: 602-255-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: