MEDICARE: AMADOR MEDICAL-ARIZONA

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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1609287283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMADOR MEDICAL-ARIZONA

Provider Business Mailing Address
First Line	:	16151 S 40TH STREET
Second Line	:	SUITE 109
City	:	PHOENIX
State	:	AZ
Zip	:	85048
Country	:	US
Telephone Number	:	702-830-0869
Fax Number	:

Provider Business Practice Location Address
First Line	:	4325 DEAN MARTIN DR
Second Line	:	SUITE 340
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4179
Country	:	US
Telephone Number	:	702-830-0869
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ANDRINA VASQUEZ
Credential	:
Telephone Number	:	702-830-0869

Provider Enumeration Date	:	05/16/2014
Last Update Date	:	05/16/2014

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Directions to “AMADOR MEDICAL-ARIZONA ” Practice Location

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