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General NPI Number Information
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NPI Number | 1407109127
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Entity Type | Organization
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Legal Business Name | AFC OF AVONDALE, PLLC
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 210 N AVONDALE BLVD STE 100
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City | AVONDALE
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State | AZ
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Zip | 85323-6906
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Country | US
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Telephone | 623-882-0600
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Fax | 623-882-9559
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Provider Business Mailing Address
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Address Line | 1839 S ALMA SCHOOL RD STE 354
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City | MESA
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State | AZ
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Zip | 85210-3028
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Country | US
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Telephone | 480-726-2287
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Fax | 888-315-4172
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | URISSA FRANCILLE BOLINE
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Credential |
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Telephone | 480-726-2287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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