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General NPI Number Information
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NPI Number | 1033128293
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Entity Type | Organization
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Legal Business Name | CAMELBACK WEST MEDICAL CLINIC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5630 W CAMELBACK RD SUITE105
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City | GLENDALE
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State | AZ
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Zip | 85301-7443
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Country | US
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Telephone | 623-337-3318
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Fax | 623-872-9704
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Provider Business Mailing Address
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Address Line | 5630 W CAMELBACK RD SUITE105
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City | GLENDALE
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State | AZ
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Zip | 85301-7443
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Country | US
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Telephone | 623-337-3318
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Fax | 623-872-9704
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Authorized Official
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Title or Position | NPMMLLC
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Name | MRS. RUTH ETHEL SANDERS
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Credential | NP
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Telephone | 623-337-3318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 261Q00000X
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License Number State | AZ
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