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General NPI Number Information
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NPI Number | 1417433236
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Entity Type | Organization
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Legal Business Name | SPECTRUM MEDICAL CARE CENTER
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Dates
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Enumeration Date | 07/15/2018
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 52 E MONTEREY WAY STE A
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City | PHOENIX
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State | AZ
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Zip | 85012-2628
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Country | US
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Telephone | 480-930-4353
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Fax | 480-930-4353
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Provider Business Mailing Address
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Address Line | 52 E MONTEREY WAY STE A
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City | PHOENIX
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State | AZ
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Zip | 85012-2628
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Country | US
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Telephone | 480-930-4353
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Fax | 480-930-4353
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | JENNIFER ANN FRANKS-MITCHELL JAUREGUI
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Credential |
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Telephone | 480-930-4353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 24745
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License Number State | AZ
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