Organization
INTEGRA HOME DOCTORS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN LEONG MANGUERRA (PRESIDENT)
(773) 791-9340
Entity
Organization
Contact information
Practice address
16165 N 83RD AVE, SUITE 200, PEORIA, AZ 85382-5816
(623) 888-3014
Mailing address
16165 N 83RD AVE, SUITE 200, PEORIA, AZ 85382-5816
(623) 888-3014
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
11/11/2014
Last updated
05/23/2016
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