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NPI Code Detail

MEDICARE: INTEGRA HOME DOCTORS, INC.

MEDICARE: INTEGRA HOME DOCTORS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1295131712
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRA HOME DOCTORS, INC.
Provider Business Mailing Address
First Line : 16165 N 83RD AVE
Second Line : SUITE 200
City : PEORIA
State : AZ
Zip : 85382-5816
Country : US
Telephone Number : 623-888-3014
Fax Number :
Provider Business Practice Location Address
First Line : 16165 N 83RD AVE
Second Line : SUITE 200
City : PEORIA
State : AZ
Zip : 85382-5816
Country : US
Telephone Number : 623-888-3014
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. GLENN LEONG MANGUERRA
Credential :
Telephone Number : 773-791-9340
Provider Enumeration Date : 11/11/2014
Last Update Date : 05/23/2016

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Directions to “INTEGRA HOME DOCTORS, INC. ” Practice Location

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