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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