Healthcare Provider Details

I. General information

NPI: 1043036403
Provider Name (Legal Business Name): TRACI PRICE NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 W MOON DUST TRL
SAN TAN VALLEY AZ
85143-3062
US

IV. Provider business mailing address

70 S VAL VISTA DR # A3-634
GILBERT AZ
85296-1374
US

V. Phone/Fax

Practice location:
  • Phone: 480-630-4592
  • Fax:
Mailing address:
  • Phone: 480-630-4592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number24-1901
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number24-1901
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: