Healthcare Provider Details

I. General information

NPI: 1396171922
Provider Name (Legal Business Name): MATRIX MEDICAL NETWORK OF INDIANA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 E MOUNTAIN VIEW RD SUITE 220
SCOTTSDALE AZ
85258
US

IV. Provider business mailing address

9201 E MOUNTAIN VIEW RD SUITE 220
SCOTTSDALE AZ
85258-5199
US

V. Phone/Fax

Practice location:
  • Phone: 480-862-1701
  • Fax: 877-561-7566
Mailing address:
  • Phone: 480-862-1701
  • Fax: 877-561-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA ALVAREZ
Title or Position: DIRECTOR, CREDENTIALING
Credential:
Phone: 480-862-1695