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General NPI Number Information
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NPI Number | 1124790977
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE CERTIFICATION CENTERS PLLC
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 14628 N GIL BALCOME
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City | SURPRISE
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State | AZ
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Zip | 85379-5400
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Country | US
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Telephone | 888-316-9085
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Fax |
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Provider Business Mailing Address
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Address Line | 355 5TH AVE STE 1502
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City | PITTSBURGH
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State | PA
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Zip | 15222-2418
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Country | US
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Telephone | 888-316-9085
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | LAUREN LAU
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Credential |
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Telephone | 724-989-4564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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