Organization
PROUDLY ARIZONA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ESRA A KHALEEL MS (OWNER/MANAGER)
(323) 378-8797
Entity
Organization
Contact information
Practice address
1717 W NORTHERN AVE STE 106, PHOENIX, AZ 85021-5400
(323) 378-8797
Mailing address
4816 W BETHANY HOME RD APT 90, GLENDALE, AZ 85301-5233
(323) 378-8797
Taxonomy
Speciality
Code
Description
License number
State
342000000X
Transportation Network Company
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
09/13/2022
Last updated
09/13/2022
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