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Individual

CHANEL GORDON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1731 W BASELINE RD STE 107, MESA, AZ 85202-5730
(480) 687-2336
Mailing address
1731 W BASELINE RD STE 107, MESA, AZ 85202-5730
(513) 828-5597

Taxonomy

Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary

Other

Enumeration date
10/21/2019
Last updated
10/21/2019
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