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1790581742 NPI number — GREATER PHOENIX COLLABORATIVE CARE PC

NPI Number: 1790581742
Health Care Provider/Practitioner: GREATER PHOENIX COLLABORATIVE CARE PC

Information about “1790581742” NPI (GREATER PHOENIX COLLABORATIVE CARE PC) exists in 1790581742 in HTML format HTML  |  1790581742 in plain Text format TXT  |  1790581742 in PDF (Portable Document Format) PDF  |  1790581742 in an XML format XML  formats.

NPI Number : 1790581742 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790581742",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "GREATER PHOENIX COLLABORATIVE CARE PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 35380",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89133-5380",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "702-579-3203",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9801 N METRO PKWY E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PHOENIX",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85051-1513",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-249-0115",
    "PracticeLocationAddressFaxNumber": "602-246-0837",
    "EnumerationDate": "02/20/2025",
    "LastUpdateDate": "02/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CASTILLO",
    "AuthorizedOfficialFirstName": "EMILY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "ASSOCIATE DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "702-480-2550",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2085R0202X",
        "TaxonomyName": "Diagnostic Radiology Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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