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General NPI Number Information
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NPI Number | 1720405962
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Entity Type | Individual
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Provider Name | JAIME GORDON
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Gender | Female
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 16807 E PALISADES BLVD STE 101
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-8438
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Country | US
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Telephone | 480-765-2677
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Fax |
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Provider Business Mailing Address
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Address Line | 16457 E BAINBRIDGE AVE
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-2721
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Country | US
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Telephone | 602-725-4854
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Fax |
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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 | 374700000X
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Taxonomy Name | Technician
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License Number | 4454
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License Number State | AZ
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