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General NPI Number Information
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NPI Number | 1154732840
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Entity Type | Organization
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Legal Business Name | AZ HEALTHY PERMANENTE MANAGEMENT GROUP, INC
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 4616 N 51ST AVE SUITE 102
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City | PHOENIX
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State | AZ
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Zip | 85031-1716
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Country | US
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Telephone | 602-638-0620
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Fax | 602-638-0610
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Provider Business Mailing Address
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Address Line | 4616 N 51ST AVE SUITE 102
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City | PHOENIX
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State | AZ
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Zip | 85031-1716
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Country | US
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Telephone | 602-638-0620
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Fax | 602-638-0610
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Authorized Official
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Title or Position | CONSULTANT
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Name | DEBORAH GRACE
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Credential |
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Telephone | 602-696-3556
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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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