# NORTH GLENDALE REGENERATIVE MEDICINE CLINIC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275302291
- **Authorized official:** SETH CLARK DPM (OWNER)
- **Authorized official phone:** (801) 448-4841

## Contact information

- **Practice address:** 18301 N 79TH AVE STE F168, GLENDALE, AZ 85308-6045
- **Practice address phone:** (623) 544-9090
- **Mailing address:** 18301 N 79TH AVE STE F168, GLENDALE, AZ 85308-6045
- **Mailing address phone:** (623) 544-9090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/02/2024
- **Last updated:** 01/02/2024