Healthcare Provider Details

I. General information

NPI: 1225921877
Provider Name (Legal Business Name): JESUSA STRACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14015 N 94TH ST APT 2004
SCOTTSDALE AZ
85260-3729
US

IV. Provider business mailing address

14015 N 94TH ST APT 2004
SCOTTSDALE AZ
85260-3729
US

V. Phone/Fax

Practice location:
  • Phone: 480-930-9127
  • Fax:
Mailing address:
  • Phone: 480-930-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberD11171550
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License NumberD11171550
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: