Healthcare Provider Details

I. General information

NPI: 1831028448
Provider Name (Legal Business Name): D.G FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11242 N 19TH AVE STE 21
PHOENIX AZ
85029-4858
US

IV. Provider business mailing address

4821 N 108TH AVE
PHOENIX AZ
85037-5471
US

V. Phone/Fax

Practice location:
  • Phone: 817-707-2798
  • Fax:
Mailing address:
  • Phone: 817-707-2798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DESIRE NTAJONJORA NKOMEZI
Title or Position: OWNER
Credential:
Phone: 817-707-2798