Healthcare Provider Details

I. General information

NPI: 1124337720
Provider Name (Legal Business Name): AGAVE HEMATOLOGY ONCOLOGY CLINICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7337 E 2ND ST
SCOTTSDALE AZ
85251-5603
US

IV. Provider business mailing address

8950 S 52ND ST SUITE 101
TEMPE AZ
85284-1046
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-6234
  • Fax:
Mailing address:
  • Phone: 602-441-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS FLORES
Title or Position: PARTNER
Credential:
Phone: 602-441-9520