Healthcare Provider Details

I. General information

NPI: 1437200581
Provider Name (Legal Business Name): VICTORIA F RHODES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/07/2023
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E SHEA BLVD STE 100
PHOENIX AZ
85028-6031
US

IV. Provider business mailing address

4600 E SHEA BLVD STE 100
PHOENIX AZ
85028-6031
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-8700
  • Fax: 602-553-8142
Mailing address:
  • Phone: 602-955-8700
  • Fax: 602-553-8142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50-00-0308
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5704
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: