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Organization

LITTLE SANCTUARY HEALTH CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ADELLA CORDOVA (MANAGER)
(623) 326-1055
Entity
Organization

Contact information

Practice address
840 W SOUTHERN AVE, MESA, AZ 85210-4901
(480) 572-9759
Mailing address
840 W SOUTHERN AVE, MESA, AZ 85210-4901
(480) 572-9759

Taxonomy

Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
954275
AZ
Enumeration date
11/14/2019
Last updated
11/14/2019
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