Healthcare Provider Details

I. General information

NPI: 1225167703
Provider Name (Legal Business Name): AFFINITY GYN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 S MCCLINTOCK DR #104
TEMPE AZ
85283-3268
US

IV. Provider business mailing address

6200 S MCCLINTOCK DR #104
TEMPE AZ
85283-3268
US

V. Phone/Fax

Practice location:
  • Phone: 480-388-3666
  • Fax: 480-388-3667
Mailing address:
  • Phone: 480-388-3666
  • Fax: 480-388-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberRN082443
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberRN082443
License Number StateAZ

VIII. Authorized Official

Name: PATRICIA ANN FAUST
Title or Position: PRESIDENT
Credential: NP
Phone: 480-874-2900