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General NPI Number Information
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NPI Number | 1417766171
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Entity Type | Organization
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Legal Business Name | DEVINE DESIGN MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 2540 S EL DORADO
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City | MESA
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State | AZ
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Zip | 85202-7308
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Country | US
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Telephone | 602-882-1050
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Fax | 602-584-6075
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Provider Business Mailing Address
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Address Line | 2540 S EL DORADO
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City | MESA
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State | AZ
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Zip | 85202-7308
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Country | US
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Telephone | 602-882-1050
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Fax | 602-584-6075
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Authorized Official
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Title or Position | OWNER
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Name | MS. ROSE TAYLOR
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Credential | ACNP-BC, PMHNP-BC
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Telephone | 602-882-1050
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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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