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General NPI Number Information
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NPI Number | 1770398760
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Entity Type | Organization
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Legal Business Name | AZEVEDO INC DBA THE PATHWAY PROGRAM
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Dates
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Enumeration Date | 02/08/2025
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Last Update Date | 02/08/2025
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Provider Practice Location Address
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Address Line | 225 SEA RIDGE RD
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City | APTOS
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State | CA
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Zip | 95003-4325
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Country | US
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Telephone | 602-568-9735
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Fax | 480-921-4050
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Provider Business Mailing Address
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Address Line | 4820 S MILL AVE STE 101
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City | TEMPE
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State | AZ
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Zip | 85282-7739
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Country | US
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Telephone | 602-568-9735
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Fax | 480-921-4050
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA LOCKE AZEVEDO
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Credential |
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Telephone | 480-921-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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