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Individual

MR. ALPHONSO TAYLOR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
8528 S 49TH LN, LAVEEN, AZ 85339-2161
(480) 593-2018
Mailing address
7018 W CARSON RD, LAVEEN, AZ 85339-7030
(480) 593-2522

Taxonomy

Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
10046
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
985484
AHCCCS ID NUMBER
AZ
Enumeration date
11/29/2006
Last updated
02/20/2008
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