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General NPI Number Information
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NPI Number | 1215275433
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Entity Type | Organization
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Legal Business Name | EMERGENCY GROUP OF ARIZONA PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 2000 W BETHANY HOME RD
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City | PHOENIX
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State | AZ
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Zip | 85015-2443
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Country | US
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Telephone | 925-924-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 4637 CHABOT DR STE 104
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City | PLEASANTON
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State | CA
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Zip | 94588-2749
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Country | US
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Telephone | 925-924-1600
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Fax |
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Authorized Official
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Title or Position | DIRECTOR PROVIDER ENROLLMENT
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Name | ROBIN MOUGANIS
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Credential |
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Telephone | 856-686-4394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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