Healthcare Provider Details

I. General information

NPI: 1770023129
Provider Name (Legal Business Name): COMPREHENSIVE AMBULATORY HEALTHCARE L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2017
Last Update Date: 03/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18362 N 94TH PL
SCOTTSDALE AZ
85255-6001
US

IV. Provider business mailing address

18362 N 94TH PL
SCOTTSDALE AZ
85255-6001
US

V. Phone/Fax

Practice location:
  • Phone: 602-451-5492
  • Fax:
Mailing address:
  • Phone: 602-451-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number44077
License Number StateAZ

VIII. Authorized Official

Name: SHAVAWN PERSCHKA
Title or Position: BILLING SERVICE REPRESENTATIVE
Credential:
Phone: 602-451-5492