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General NPI Number Information
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NPI Number | 1780473108
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Entity Type | Organization
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Legal Business Name | MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 14130 W MCDOWELL RD
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City | GOODYEAR
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State | AZ
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Zip | 85395-2514
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Country | US
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Telephone | 602-291-4414
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Fax | 602-372-0342
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Provider Business Mailing Address
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Address Line | 1645 E ROOSEVELT ST
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City | PHOENIX
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State | AZ
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Zip | 85006-3638
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Country | US
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Telephone | 602-291-4414
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Fax | 602-372-0342
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Authorized Official
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Title or Position | SPECIALIZED SERVICES SUPERVISOR
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Name | JOEL KODICEK
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Credential |
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Telephone | 480-662-5475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State |
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