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General NPI Number Information
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NPI Number | 1659679900
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Entity Type | Organization
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Legal Business Name | REGIONAL PHYSICIAN SERVICES CONNECTICUT PC
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 1224 MILL ST BLDG B
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City | EAST BERLIN
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State | CT
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Zip | 06023-1159
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Country | US
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Telephone | 480-862-1677
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Fax | 480-718-7643
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Provider Business Mailing Address
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Address Line | 9201 E MOUNTAIN VIEW RD SUITE 220
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City | SCOTTSDALE
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State | AZ
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Zip | 85258
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Country | US
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Telephone | 480-862-1700
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Fax | 480-907-1537
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Authorized Official
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Title or Position | DIRECTOR, CREDENTIALING
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Name | VICTORIA ALVAREZ
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Credential |
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Telephone | 480-862-1695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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