Individual
YSIS MARTJA CAMPECHANO GRULLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1514 W THOMAS RD, PHOENIX, AZ 85015-6101
(602) 283-5732
Mailing address
1514 W THOMAS RD, PHOENIX, AZ 85015-6101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8580
AZ
Other
Enumeration date
03/21/2022
Last updated
01/23/2023
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