Healthcare Provider Details

I. General information

NPI: 1669142774
Provider Name (Legal Business Name): YOSHI GROOMS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YOSHI CASTRO

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 N 53RD AVE STE 160
PHOENIX AZ
85031-3038
US

IV. Provider business mailing address

4137 N 108TH AVE
PHOENIX AZ
85037-5459
US

V. Phone/Fax

Practice location:
  • Phone: 623-877-7337
  • Fax: 623-772-0686
Mailing address:
  • Phone: 623-877-7337
  • Fax: 623-772-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number257409
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: