Healthcare Provider Details

I. General information

NPI: 1518379031
Provider Name (Legal Business Name): HEATHERANN ALISON BAL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHERANN ALISON BRUNELL D.O.

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

PO BOX 95460
CLEVELAND OH
44101-0033
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-1200
  • Fax: 602-263-1619
Mailing address:
  • Phone: 602-581-6076
  • Fax: 602-263-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number007080
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: