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General NPI Number Information
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NPI Number | 1639387533
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Entity Type | Organization
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Legal Business Name | SOUTHWEST PRIMARY CARE
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 1315 W SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-4519
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Country | US
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Telephone | 480-705-9413
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Fax | 480-705-0858
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Provider Business Mailing Address
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Address Line | 1315 W SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-4519
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Country | US
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Telephone | 480-705-9413
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Fax | 480-705-0858
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. VERNA M PALACIO
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Credential |
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Telephone | 480-626-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1876
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License Number State | AZ
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