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General NPI Number Information
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NPI Number | 1932608106
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Entity Type | Organization
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Legal Business Name | STAR CLINIC LLC
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 04/27/2025
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Provider Practice Location Address
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Address Line | 14155 N 83RD AVE STE 138
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City | PEORIA
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State | AZ
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Zip | 85381-5652
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Country | US
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Telephone | 623-271-8666
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Fax | 623-271-9229
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Provider Business Mailing Address
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Address Line | PO BOX 72300
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City | PHOENIX
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State | AZ
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Zip | 85050-1022
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Country | US
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Telephone | 623-271-8666
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Fax | 623-271-8666
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. TARA YEGANEH
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Credential |
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Telephone | 623-271-8666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 38152
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License Number State | AZ
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