Organization
FORWARD CARE FAMILY PRACTICE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLANA DAVIDOV (AUTHORIZED OFFICIAL/OWNER)
(602) 373-8968
Entity
Organization
Contact information
Practice address
7800 N 55TH AVE, GLENDALE, AZ 85301-1321
(602) 373-8968
Mailing address
2428 W WOBURN LN, PHOENIX, AZ 85085-5031
(602) 373-8968
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/23/2020
Last updated
10/26/2020
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