Organization
CLEAN COLONIC FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN BERRY (OWNER)
(480) 269-5575
Entity
Organization
Contact information
Practice address
4744 E THUNDERBIRD RD STE 4, PHOENIX, AZ 85032-5577
(480) 269-5575
Mailing address
4744 E THUNDERBIRD RD STE 4, PHOENIX, AZ 85032-5577
(480) 269-5575
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
03/19/2021
Last updated
03/19/2021
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