=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073489266
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROLETE HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2025
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 W UNION HILLS DR STE 104
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85027-5633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-666-5505
-----------------------------------------------------
Fax | 480-666-5505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 W UNION HILLS DR STE 104
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85027-5633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-666-5505
-----------------------------------------------------
Fax | 480-666-5505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. UBONG ATTAH PRINCE
-----------------------------------------------------
Credential | NMD
-----------------------------------------------------
Telephone | 480-666-5505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------