Healthcare Provider Details

I. General information

NPI: 1861028383
Provider Name (Legal Business Name): SUSAN FRUCHTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17797 N PERIMETER DR STE 109
SCOTTSDALE AZ
85255-5455
US

IV. Provider business mailing address

17797 N PERIMETER DR STE 109
SCOTTSDALE AZ
85255-5455
US

V. Phone/Fax

Practice location:
  • Phone: 480-473-0115
  • Fax:
Mailing address:
  • Phone: 480-473-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: