Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2020-12-12
- Last updated
- 2020-12-12
Specialties
Licenses
- License AZ
- S015364
Location
- Practice location
- 10325 E RIGGS RD
- City
- SUN LAKES AZ
- Postal code
- 852487623
- Phone
- 480-802-7182
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.