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Specialty details in registry · Phoenix, AZ
At a glance
1717 W Northern Ave Ste D&E, Phoenix, AZ 85021-5469
NPPES record updated May 7, 2026. Public records can lag behind changes at a practice.
Before you call: a quick checklist
- Are you accepting new patients?
- Do you accept my specific insurance plan?
- Do you provide the service I need at this address?
- Do I need a referral, and what is the earliest appointment?
Insurance participation and appointment availability are not established by these public records.
Practice location
1717 W Northern Ave Ste D&EPhoenix, AZ 85021-5469
Professional details: NPI, taxonomy & registry record
Registry details
- Primary taxonomy
- Specialty details in registry
- Taxonomy code
- 251S00000X
- Enumeration date
- Oct 24, 2019
- Record updated
- May 7, 2026
More registry details
- Provider type
- Organization · Type 2
- Other reported name
- <UNAVAIL>
Reported taxonomies and licenses
Specialty details in registry
251S00000X · Primary
License numbers and credentials are reported to NPPES; HCPList does not independently verify them.
Practice location
1717 W Northern Ave Ste D&EPhoenix, AZ 85021-5469
- Phone
- (406) 688-6194
Mailing address
1717 W NORTHERN AVE STE D&EPHOENIX, AZ 850215469
Information may be outdated or incomplete.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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