Healthcare Provider Details

I. General information

NPI: 1730506437
Provider Name (Legal Business Name): WHITE CRANES MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 S COTTONWOOD DR
TEMPE AZ
85282-3014
US

IV. Provider business mailing address

2050 S COTTONWOOD DR
TEMPE AZ
85282-3014
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-4540
  • Fax: 206-588-1015
Mailing address:
  • Phone: 480-704-4540
  • Fax: 206-588-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: JELINA M IP
Title or Position: ADMINISTRATOR
Credential:
Phone: 206-799-2193