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General NPI Number Information
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NPI Number | 1477107787
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Entity Type | Organization
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Legal Business Name | MAZOURY FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 4913 S ALMA SCHOOL RD STE 4
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City | CHANDLER
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State | AZ
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Zip | 85248-5629
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Country | US
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Telephone | 480-371-4559
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Fax |
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Provider Business Mailing Address
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Address Line | 4087 E WASHINGTON AVE
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City | GILBERT
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State | AZ
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Zip | 85234-7711
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ALIREZA MAZOURY
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Credential | NP
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Telephone | 480-371-4559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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