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General NPI Number Information
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NPI Number | 1538250535
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Entity Type | Organization
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Legal Business Name | DESERT MISSION INC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 9201 N 5TH ST
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City | PHOENIX
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State | AZ
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Zip | 85020-2532
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Country | US
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Telephone | 602-331-5779
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Fax | 602-870-6348
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Provider Business Mailing Address
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Address Line | 9201 N 5TH ST
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City | PHOENIX
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State | AZ
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Zip | 85020-2532
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Country | US
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Telephone | 602-331-5779
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Fax | 602-870-6348
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MS. CINDY HALLMAN
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Credential |
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Telephone | 602-870-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | OTC3971
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License Number State | AZ
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