Organization
PHOENIX PROVIDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AARON LEE VAN PELT (CEO)
(775) 722-0574
Entity
Organization
Contact information
Practice address
3844 JOY LN, RENO, NV 89523
(775) 722-0574
Mailing address
3844 JOY LN, RENO, NV 89523
(775) 722-0574
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
NV20151498467
NV
Other
Enumeration date
09/01/2015
Last updated
09/01/2015
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