Healthcare Provider Details

I. General information

NPI: 1033702519
Provider Name (Legal Business Name): FIDEL PSYCHIATRIC HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 W JESSICA LN
PHOENIX AZ
85041-3978
US

IV. Provider business mailing address

924 W JESSICA LN
PHOENIX AZ
85041-3978
US

V. Phone/Fax

Practice location:
  • Phone: 480-332-8764
  • Fax: 602-323-1769
Mailing address:
  • Phone: 480-332-8764
  • Fax: 602-323-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. FIDELIS OSONDU EBEREONWU
Title or Position: DIRECTOR
Credential: MSN PMHNP-BC
Phone: 480-332-8764