Healthcare Provider Details

I. General information

NPI: 1659679900
Provider Name (Legal Business Name): REGIONAL PHYSICIAN SERVICES CONNECTICUT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 MILL ST BLDG B
EAST BERLIN CT
06023-1159
US

IV. Provider business mailing address

9201 E MOUNTAIN VIEW RD SUITE 220
SCOTTSDALE AZ
85258
US

V. Phone/Fax

Practice location:
  • Phone: 480-862-1677
  • Fax: 480-718-7643
Mailing address:
  • Phone: 480-862-1700
  • Fax: 480-907-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA ALVAREZ
Title or Position: DIRECTOR, CREDENTIALING
Credential:
Phone: 480-862-1695