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General NPI Number Information
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NPI Number | 1851583546
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Entity Type | Organization
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Legal Business Name | FERMO & TAN FERMO L L C
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 12/30/2018
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Provider Practice Location Address
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Address Line | 2545 W QUAIL AVE
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City | PHOENIX
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State | AZ
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Zip | 85027-2418
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Country | US
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Telephone | 480-235-5579
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Fax | 602-368-1140
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Provider Business Mailing Address
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Address Line | PO BOX 5655
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City | GLENDALE
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State | AZ
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Zip | 85312-5655
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Country | US
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Telephone | 480-235-5579
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Fax | 602-368-1140
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHIRLEY T BAKER
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Credential |
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Telephone | 602-380-9644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 28317
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License Number State | AZ
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