Healthcare Provider Details

I. General information

NPI: 1023852928
Provider Name (Legal Business Name): FIRST PERSON CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 S RURAL RD
TEMPE AZ
85282-1411
US

IV. Provider business mailing address

1200 S 4TH ST STE 111
LAS VEGAS NV
89104-1046
US

V. Phone/Fax

Practice location:
  • Phone: 702-380-8118
  • Fax:
Mailing address:
  • Phone: 702-380-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY KARANIUK
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 480-447-6841