Healthcare Provider Details

I. General information

NPI: 1700196672
Provider Name (Legal Business Name): HANFORD CONSULTATIONS P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 22ND PLACE SUITE 100
LUBBOCK TX
79410
US

IV. Provider business mailing address

PO BOX 65052
LUBBOCK TX
79490
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-7070
  • Fax:
Mailing address:
  • Phone: 806-761-0334
  • Fax: 806-722-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG6723
License Number StateTX

VIII. Authorized Official

Name: JENNETT AZZINARO
Title or Position: MANAGER
Credential:
Phone: 806-761-0334