Healthcare Provider Details

I. General information

NPI: 1700597473
Provider Name (Legal Business Name): ELIZABETH MEITAMEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E SOUTHERN AVE APT 29
TEMPE AZ
85282-5619
US

IV. Provider business mailing address

4449 N 12TH ST
PHOENIX AZ
85014-4520
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-1427
  • Fax:
Mailing address:
  • Phone: 602-279-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: