Individual
EZEKIEL AGBAEZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3535 W HOPI TRL, LAVEEN, AZ 85339-1408
(480) 599-9318
Mailing address
3535 W HOPI TRL, LAVEEN, AZ 85339-1408
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D08392069
AZ
Other
Enumeration date
08/23/2023
Last updated
08/31/2023
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