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General NPI Number Information
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NPI Number | 1033201140
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Entity Type | Organization
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Legal Business Name | WEST PARK MEDICAL CORP
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 4136 N 75TH AVE SUITE 116
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City | PHOENIX
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State | AZ
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Zip | 85033-3171
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Country | US
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Telephone | 623-849-1869
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Fax | 623-849-5880
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Provider Business Mailing Address
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Address Line | 4136 N 75TH AVE #116
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City | PHOENIX
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State | AZ
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Zip | 85033-3100
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Country | US
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Telephone | 623-849-1869
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Fax | 623-849-5880
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | KARLA ROWLETTE
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Credential |
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Telephone | 623-849-1869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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