=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083524433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASA DEL FENIX PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2026
-----------------------------------------------------
Last Update Date | 09/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 48739 N 5TH AVE
-----------------------------------------------------
City | NEW RIVER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85087-8581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-456-5607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4539 N 22ND ST STE N
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-4639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-456-5607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LEO O MERINO
-----------------------------------------------------
Credential | MA, LPC
-----------------------------------------------------
Telephone | 602-456-5607
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------