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Specialty details in registry · Tolleson, AZ

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At a glance

4050 S 94Th Ln, Tolleson, AZ 85353-5745

NPPES record updated Jun 25, 2024. Public records can lag behind changes at a practice.

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Practice location

4050 S 94Th Ln
Tolleson, AZ 85353-5745

Professional details: NPI, taxonomy & registry record

NPI1306680111

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 320600000X
Enumeration date: Jun 25, 2024
Record updated: Jun 25, 2024

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

320600000X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

4050 S 94Th Ln
Tolleson, AZ 85353-5745

Phone: (623) 385-2064

Mailing address

6751 N SUNSET BLVD STE 320

GLENDALE, AZ 853053155

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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