Healthcare Provider Details

I. General information

NPI: 1265490783
Provider Name (Legal Business Name): ALBERT JESUS GAMEZ JR. MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 N 3RD ST SUITE 170
PHOENIX AZ
85004-1471
US

IV. Provider business mailing address

6340 S RURAL RD #118-209
TEMPE AZ
85283-2932
US

V. Phone/Fax

Practice location:
  • Phone: 602-794-2678
  • Fax: 602-462-1186
Mailing address:
  • Phone: 602-663-4057
  • Fax: 602-462-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP2059
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: