Organization
PROVIDENCE GENERAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BLANCA MARQUEZ (MANAGER)
(602) 254-7077
Entity
Organization
Contact information
Practice address
1701 W GLENDALE AVE, PHOENIX, AZ 85021-9701
(602) 246-9090
(602) 246-9867
Mailing address
1701 W GLENDALE AVE, PHOENIX, AZ 85021-9701
(602) 246-9090
(602) 246-9867
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
AP3603
AZ
Other
Enumeration date
03/25/2010
Last updated
03/25/2010
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