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NPI Code Detail

MEDICARE: GREATER PHOENIX COLLABORATIVE CARE PC

MEDICARE: GREATER PHOENIX COLLABORATIVE CARE PC
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
12085R0202XDiagnostic Radiology Physician

General Provider Information

NPI Number : 1790581742
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREATER PHOENIX COLLABORATIVE CARE PC
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-579-3203
Fax Number :
Provider Business Practice Location Address
First Line : 9801 N METRO PKWY E
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-1513
Country : US
Telephone Number : 602-249-0115
Fax Number : 602-246-0837
Authorized Official
Title or Position : ASSOCIATE DIRECTOR
Name : EMILY CASTILLO
Credential :
Telephone Number : 702-480-2550
Provider Enumeration Date : 02/20/2025
Last Update Date : 02/20/2025

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Directions to “GREATER PHOENIX COLLABORATIVE CARE PC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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