Individual
COLETTE ENEBOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1015 S VAL VISTA DR UNIT 27, MESA, AZ 85204-5674
(602) 920-4041
Mailing address
1015 S VAL VISTA DR UNIT 27, MESA, AZ 85204-5674
(602) 920-4041
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0999
AZ
Other
Enumeration date
07/01/2015
Last updated
07/01/2015
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