Organization
PUERTO SONORA INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN PANGALLO (ACCOUNTING MANAGER - CREDENTIALING)
(702) 375-5777
Entity
Organization
Contact information
Practice address
4653 S LAKESHORE DR STE 3, TEMPE, AZ 85282-7161
(480) 456-8981
(480) 456-2906
Mailing address
4653 S LAKESHORE DR STE 3, TEMPE, AZ 85282-7161
(480) 456-8981
(480) 456-2906
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
03/25/2021
Last updated
02/28/2023
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