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General NPI Number Information
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NPI Number | 1730748435
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Entity Type | Organization
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Legal Business Name | NEXT GEN MEDICUS
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 2075 S COTTONWOOD DR
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City | TEMPE
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State | AZ
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Zip | 85282-3040
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Country | US
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Telephone | 602-362-1823
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Fax |
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Provider Business Mailing Address
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Address Line | 2075 S COTTONWOOD DR
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City | TEMPE
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State | AZ
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Zip | 85282-3040
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Country | US
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Telephone | 602-362-1823
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | CRYSTAL ALEJO
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Credential |
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Telephone | 480-703-1883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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