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General NPI Number Information
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NPI Number | 1558024943
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Entity Type | Organization
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Legal Business Name | AUTHENTIGO HEALTH
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 1166 E WARNER RD STE 101
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City | GILBERT
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State | AZ
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Zip | 85296-3065
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Country | US
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Telephone | 480-980-6330
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Fax | 480-485-1666
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Provider Business Mailing Address
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Address Line | 1166 E WARNER RD STE 101
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City | GILBERT
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State | AZ
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Zip | 85296-3065
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Country | US
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Telephone | 480-980-6330
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Fax |
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Authorized Official
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Title or Position | PRINCIPLE
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Name | DIANE R STRICKER
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Credential | ANP, LCSW
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Telephone | 480-980-6330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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