Individual
BOL GACH PAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9250 N 75TH AVE LOT 48, PEORIA, AZ 85345-6634
(602) 481-0911
Mailing address
8050 N 19TH AVE # 101, PHOENIX, AZ 85021-5101
(602) 481-0911
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
D06464178
AZ
Other
Enumeration date
10/04/2023
Last updated
10/04/2023
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