Healthcare Provider Details

I. General information

NPI: 1831606144
Provider Name (Legal Business Name): CONCIERGE HEALTHCARE OF AZ CHAZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 E DOUBLETREE RANCH RD STE 300
SCOTTSDALE AZ
85258-2132
US

IV. Provider business mailing address

7702 E DOUBLETREE RANCH RD STE 300
SCOTTSDALE AZ
85258-2132
US

V. Phone/Fax

Practice location:
  • Phone: 480-348-8006
  • Fax: 480-718-7537
Mailing address:
  • Phone: 480-348-8006
  • Fax: 480-401-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number16208
License Number StateAZ

VIII. Authorized Official

Name: SIMONE M JUHL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 602-565-8830