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General NPI Number Information
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NPI Number | 1487920104
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Entity Type | Organization
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Legal Business Name | ESTRELLA PKWY MEDICAL CENTER
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 530 N. ESTRELLA PKWY C-1
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City | GOODYEAR
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State | AZ
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Zip | 85338-4138
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Country | US
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Telephone | 623-932-9211
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Fax |
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Provider Business Mailing Address
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Address Line | 530 N. ESTRELLA PKWY C-1
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City | GOODYEAR
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State | AZ
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Zip | 85338-4138
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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 | MANAGER
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Name | BRION MUSCARELLA
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Credential |
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Telephone | 623-932-9211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7681
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 19987
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License Number State | AZ
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