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General NPI Number Information
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NPI Number | 1750919023
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Entity Type | Individual
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Provider Name | JALICIA STURDIVANT DO
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Gender | Female
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 15351 W BELL RD
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City | SURPRISE
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State | AZ
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Zip | 85374-4580
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Country | US
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Telephone | 480-964-2273
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Fax | 623-214-5214
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Provider Business Mailing Address
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Address Line | 3033 N CENTRAL AVE STE 145
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City | PHOENIX
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State | AZ
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Zip | 85012-2808
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Country | US
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Telephone | 480-964-2273
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Fax | 623-974-6721
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 95609
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 010924
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License Number State | AZ
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