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General NPI Number Information
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NPI Number | 1871314617
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Entity Type | Individual
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Provider Name | MR. PHILIP RHANIS AJUESHI
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Gender | Male
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 17496 W ELAINE DR
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City | GOODYEAR
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State | AZ
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Zip | 85338-1981
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Country | US
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Telephone | 917-388-6134
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Fax |
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Provider Business Mailing Address
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Address Line | 29962 W AVALON DR
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City | BUCKEYE
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State | AZ
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Zip | 85396-3179
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Country | US
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Telephone | 435-703-4465
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | AZ
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