Individual
DIVA BACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11788 E ARABELLE DR, VAIL, AZ 85641-0709
(520) 488-0614
Mailing address
4539 N 22ND ST STE N, PHOENIX, AZ 85016-4639
(520) 488-0614
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
AZ
Other
Enumeration date
06/02/2025
Last updated
06/02/2025
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