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General NPI Number Information
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NPI Number | 1124479910
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Entity Type | Organization
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Legal Business Name | HONOR FAMILY HEALTHCARE, LLC
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 300 W WHITE MOUNTAIN BLVD SUITE D
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City | LAKESIDE
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State | AZ
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Zip | 85929-7014
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Country | US
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Telephone | 928-368-4547
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Fax | 928-368-4527
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Provider Business Mailing Address
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Address Line | 300 W WHITE MOUNTAIN BLVD SUITE D
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City | LAKESIDE
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State | AZ
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Zip | 85929-7014
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Country | US
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Telephone | 928-368-4547
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Fax | 928-368-4527
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ARLINDA M CORONADO
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Credential |
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Telephone | 928-368-4547
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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 | D02923
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License Number State | AZ
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