Healthcare Provider Details

I. General information

NPI: 1275463036
Provider Name (Legal Business Name): ANDREW JOSEPH CZOSEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W CAMELBACK RD
PHOENIX AZ
85017-1097
US

IV. Provider business mailing address

10537 E OTTOMAN DR
TUCSON AZ
85747-0909
US

V. Phone/Fax

Practice location:
  • Phone: 602-639-7500
  • Fax:
Mailing address:
  • Phone: 520-591-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN179053
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: