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Organization
AKOS LIVE
Active
Organization
AKOS LIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESERIE TSOSIE (CREDENTIALING)
(661) 673-6726
Entity
Organization
Contact information
Practice address
20205 N 67TH AVE, GLENDALE, AZ 85308-6659
(844) 900-2567
Mailing address
20565 N 19TH AVE, PHOENIX, AZ 85027-3563
(661) 673-6726
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
2083X0100X
Occupational Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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