Healthcare Provider Details

I. General information

NPI: 1902755432
Provider Name (Legal Business Name): ALLAN JEFF BISCOCHO BARTOLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 N 51ST AVE STE 108
PHOENIX AZ
85031-1720
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 400
PHOENIX AZ
85012-2929
US

V. Phone/Fax

Practice location:
  • Phone: 602-285-6800
  • Fax: 602-269-8410
Mailing address:
  • Phone: 602-285-6800
  • Fax: 602-302-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number232678
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: