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General NPI Number Information
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NPI Number | 1669942645
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Entity Type | Organization
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Legal Business Name | GOLDEN TRINITY HEALTHCARE LLC
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 40616 W ART PL
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City | MARICOPA
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State | AZ
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Zip | 85138-5221
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Country | US
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Telephone | 480-567-2526
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Fax | 480-750-2444
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Provider Business Mailing Address
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Address Line | 20987 N JOHN WAYNE PKWY # B104-215
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City | MARICOPA
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State | AZ
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Zip | 85139-2926
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Country | US
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Telephone | 480-567-2526
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Fax | 480-750-2444
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Authorized Official
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Title or Position | PROVIDER
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Name | TANDRA GARVIN
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Credential |
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Telephone | 480-567-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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