Organization
TRANSFORMATIVE MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE BENNETT WALLACE (CEO)
(480) 482-8128
Entity
Organization
Contact information
Practice address
2450 S GILBERT RD STE 109, CHANDLER, AZ 85286-1594
(480) 899-4333
Mailing address
2425 S STEARMAN DR STE 205, CHANDLER, AZ 85286-5042
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
01/16/2023
Last updated
01/16/2023
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