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General NPI Number Information
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NPI Number | 1417119108
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Entity Type | Organization
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Legal Business Name | WOMEN'S MEDICAL GROUP OF TEMPE
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 4915 E BASELINE RD STE 104
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City | GILBERT
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State | AZ
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Zip | 85234-2966
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Country | US
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Telephone | 480-632-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 4915 E BASELINE RD STE 104
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City | GILBERT
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State | AZ
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Zip | 85234-2966
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Country | US
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Telephone | 480-632-2004
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR/ BILLER
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Name | MS. CLAUDIA MARIA SEVILLANO
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Credential |
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Telephone | 480-632-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 33219
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License Number State | AZ
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