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General NPI Number Information
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NPI Number | 1164776845
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Entity Type | Organization
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Legal Business Name | CAMELBACK MOUNTAIN MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 120 E MONTEREY WAY
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City | PHOENIX
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State | AZ
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Zip | 85012-2618
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Country | US
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Telephone | 602-266-4383
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Fax | 602-266-4384
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Provider Business Mailing Address
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Address Line | 120 E MONTEREY WAY
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City | PHOENIX
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State | AZ
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Zip | 85012-2618
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Country | US
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Telephone | 602-266-4383
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Fax | 602-266-4384
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. EDWARD GRIFFIN CIPOLLA
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Credential | DO
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Telephone | 602-266-4383
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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 | 2811
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License Number State | AZ
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