Organization
PONDEROSA HEART HOUSE CALL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STARLA LUCILLE MILLER RN (CHIEF OPERATIONS OFFICER)
(480) 365-8454
Entity
Organization
Contact information
Practice address
2162 E WILLIAMS FIELD RD STE 111, GILBERT, AZ 85295-0736
(480) 795-1515
(480) 597-1723
Mailing address
2162 E WILLIAMS FIELD RD STE 111, GILBERT, AZ 85295-0736
(480) 795-1515
(480) 597-1723
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080154
—
AZ
01
—
OTC13482
AZ STATE LICENSE
AZ
Enumeration date
07/10/2020
Last updated
09/09/2024
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