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General NPI Number Information
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NPI Number | 1093217713
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Entity Type | Organization
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Legal Business Name | WESTERN MOBILE MEDICAL
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 18441 N 25TH AVE STE 103
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City | PHOENIX
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State | AZ
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Zip | 85023-1256
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Country | US
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Telephone | 480-246-3275
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Fax | 480-246-3274
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Provider Business Mailing Address
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Address Line | 18441 N 25TH AVE STE 103
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City | PHOENIX
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State | AZ
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Zip | 85023-1256
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Country | US
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Telephone | 480-246-3275
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Fax | 480-246-3274
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Authorized Official
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Title or Position | CEO
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Name | DEBRA LASETER
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Credential | NP
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Telephone | 480-246-3275
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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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