Healthcare Provider Details

I. General information

NPI: 1629013263
Provider Name (Legal Business Name): ARIZONA STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E UNIVERSITY DR
TEMPE AZ
85281-5390
US

IV. Provider business mailing address

PO BOX 872104
TEMPE AZ
85287-2104
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-3346
  • Fax: 480-965-2269
Mailing address:
  • Phone: 480-965-3346
  • Fax: 480-965-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA HOERTZ
Title or Position: MEDICAL DIRECTOR
Credential: DO, MPH
Phone: 561-699-4466