Healthcare Provider Details

I. General information

NPI: 1720107659
Provider Name (Legal Business Name): P S MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W BUCKEYE RD SUITE 402
PHOENIX AZ
85003-2647
US

IV. Provider business mailing address

4530 E RAY RD SUITE 178
PHOENIX AZ
85044-6094
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-9229
  • Fax:
Mailing address:
  • Phone: 480-759-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2674
License Number StateAZ

VIII. Authorized Official

Name: DR. JOANNE PADILLA
Title or Position: PHYSICIAN ASSISTANT
Credential: MD
Phone: 602-257-9229