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General NPI Number Information
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NPI Number | 1063165504
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Entity Type | Organization
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Legal Business Name | EMBRY TESTING AND VACCINES OF NEW MEXICO LLC
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 4717 E HILTON AVE STE 250
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City | PHOENIX
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State | AZ
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Zip | 85034-6400
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Country | US
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Telephone | 480-701-3322
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Fax |
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Provider Business Mailing Address
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Address Line | 3370 N HAYDEN RD STE 123-215
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6632
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Country | US
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Telephone | 480-701-3322
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF RCM
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Name | MAKESHA FUQUA
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Credential |
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Telephone | 480-801-7975
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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 |
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License Number State |
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