# CTHVAMC

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

## Provider details

- **NPI number:** 1811176530
- **Authorized official:** MR. MICHAEL LYNN GHIDOTTI COTA/L (COTA)
- **Authorized official phone:** (602) 277-5551

## Contact information

- **Practice address:** 239 W UTOPIA RD, PHOENIX, AZ 85027-4738
- **Practice address phone:** (602) 277-5551
- **Mailing address:** 239 W UTOPIA RD, PHOENIX, AZ 85027-4738

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QV0200X | VA Clinic/Center | 4023 | AZ | Yes |

## Other

- **Enumeration date:** 10/30/2007
- **Last updated:** 10/30/2007