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General NPI Number Information
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NPI Number | 1225275829
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Entity Type | Organization
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Legal Business Name | PMM HEALTHCARE
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 01/19/2009
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Provider Practice Location Address
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Address Line | 4660 W THOMAS RD STE-A
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City | PHOENIX
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State | AZ
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Zip | 85031-3718
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Country | US
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Telephone | 602-442-4500
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Fax | 602-442-4505
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Provider Business Mailing Address
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Address Line | 4660 W THOMAS RD STE A
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City | PHOENIX
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State | AZ
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Zip | 85031-3718
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Country | US
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Telephone | 602-442-4500
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Fax | 602-442-4505
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Authorized Official
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Title or Position | OFFICE FACILITATOR
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Name | MR. MARK C DELALAMA
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Credential | PA-C
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Telephone | 602-442-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 33819
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License Number State | AZ
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