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General NPI Number Information
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NPI Number | 1174722458
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Entity Type | Organization
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Legal Business Name | SANTE PERSONALIZED PREVENTIVE HEALTHCARE, PLLC
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 12/28/2007
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Provider Practice Location Address
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Address Line | 2620 N 3RD ST SUITE 103
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City | PHOENIX
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State | AZ
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Zip | 85004-1153
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Country | US
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Telephone | 602-595-3321
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Fax | 602-358-8451
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Provider Business Mailing Address
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Address Line | 2620 N 3RD ST SUITE 103
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City | PHOENIX
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State | AZ
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Zip | 85004-1153
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Country | US
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Telephone | 602-595-3321
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Fax | 602-358-8451
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JOHN MCBARRON HODGSON
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Credential | MD
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Telephone | 602-595-3321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 32892
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License Number State | AZ
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