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General NPI Number Information
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NPI Number | 1770348724
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Entity Type | Organization
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Legal Business Name | AMERICAN FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 9169 W VAN BUREN ST
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City | TOLLESON
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State | AZ
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Zip | 85353-2942
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Country | US
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Telephone | 623-233-6676
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 W THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85015-6101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ALEJANDRO E LOPEZ
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Credential |
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Telephone | 832-454-9989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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