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General NPI Number Information
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NPI Number | 1639798143
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Entity Type | Individual
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Provider Name | ANTHONY UDOINWANG
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Gender | Male
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 10435 W READE AVE
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City | GLENDALE
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State | AZ
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Zip | 85307-4237
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Country | US
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Telephone | 623-594-0997
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Fax | 623-594-0998
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Provider Business Mailing Address
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Address Line | PO BOX 14392
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City | PHOENIX
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State | AZ
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Zip | 85063-4392
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Country | US
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Telephone | 602-757-4861
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Fax | 623-594-0998
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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