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General NPI Number Information
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NPI Number | 1851637631
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Entity Type | Individual
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Provider Name | ALIREZA MAZOURY FNP
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Gender | Male
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Dates
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Enumeration Date | 12/22/2012
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 3000 N ARIZONA AVE
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City | CHANDLER
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State | AZ
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Zip | 85225-7717
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Country | US
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Telephone | 480-371-4559
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 S CLEARVIEW AVE STE 100
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City | MESA
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State | AZ
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Zip | 85209-3378
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Country | US
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Telephone | 480-371-4559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP4785
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License Number State | AZ
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