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General NPI Number Information
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NPI Number | 1790022234
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Entity Type | Organization
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Legal Business Name | PHOENIX VA HEALTH CARE SYSTEM
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 650 E INDIAN SCHOOL RD
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City | PHOENIX
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State | AZ
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Zip | 85012-1839
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Country | US
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Telephone | 602-277-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 15231 N 66TH DR
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City | GLENDALE
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State | AZ
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Zip | 85306-3117
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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 | REGISTERED DIETITIAN
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Name | MS. JENNIE GUAN
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Credential |
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Telephone | 305-277-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | 1082914
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License Number State | AZ
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