Individual
CLOSEL DEFONSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7812 W WOOD LN, PHOENIX, AZ 85043-1426
(310) 956-7616
Mailing address
7812 W WOOD LN, PHOENIX, AZ 85043-1426
(602) 416-1944
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
843051441
—
AZ
Enumeration date
05/28/2020
Last updated
05/28/2020
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