Individual
SAMUEL RAEYU YACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
N/A
Contact information
Practice address
2524 W ELM ST, PHOENIX, AZ 85017-3639
(480) 227-2603
Mailing address
2524 W ELM ST, PHOENIX, AZ 85017-3639
(480) 227-2603
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D09767801
AZ
Other
Enumeration date
04/16/2024
Last updated
04/16/2024
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