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Organization

MLM FAMILY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LANA KHATIB PA-C (PROVIDER)
(602) 339-3669
Entity
Organization

Contact information

Practice address
15410 S MOUNTAIN PKWY, SUITE 105, PHOENIX, AZ 85044-6691
(602) 339-3669
Mailing address
2031 E GLENHAVEN DR, PHOENIX, AZ 85048-8122
(602) 339-3669

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42064
AZ
363AM0700X
Medical Physician Assistant
5212
AZ

Other

Enumeration date
07/24/2014
Last updated
07/24/2014
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