Healthcare Provider Details

I. General information

NPI: 1376308544
Provider Name (Legal Business Name): STEVE REUPENA STEVE REUPENA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 W CROWN KING RD
TOLLESON AZ
85353-8639
US

IV. Provider business mailing address

10517 W TORONTO WAY
TOLLESON AZ
85353-5630
US

V. Phone/Fax

Practice location:
  • Phone: 602-677-2206
  • Fax:
Mailing address:
  • Phone: 602-677-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number99-1222703
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number99-1222703
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: