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Clinic/Center in Surprise, AZ. Organization (NPI-2).
NPI number1801586748
StatusActive
Last updated in NPPESMay 12, 2023
Details
- NPI
- 1801586748
- Entity type
- Organization (NPI-2)
- Legal business name
- Choose To Change
- Organization subpart
- No
- Enumeration date
- May 12, 2023
- Certification date
- May 12, 2023
- Last updated
- May 12, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Practice location
15148 W Cortez StSurprise, AZ 85379-5237
Phone 708-275-9244
Mailing address
15148 W Cortez StSurprise, AZ 85379-5237
Authorized official
Jermaine Davis
Coo
7082759244
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