Organization
CHICANOD POR LA CAUSA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOMINGO RODRIGUEZ (EXECUTIVE VICE PRESIDENT)
(602) 254-4827
Entity
Organization
Contact information
Practice address
1402 S CENTRAL AVE, PHOENIX, AZ 85004-2801
(602) 257-5530
Mailing address
1046 E BUCKEYE RD, PHOENIX, AZ 85034-4041
(602) 254-4827
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
BH-476
AZ
Other
Enumeration date
09/20/2006
Last updated
08/22/2020
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