Organization
DVM PAIN GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICKI MANCUSO (OFFICE ADMINISTRATOR)
(480) 510-3567
Entity
Organization
Contact information
Practice address
18205 N 51ST AVE, SUITE 113, GLENDALE, AZ 85308-1490
(602) 354-4370
(602) 354-4370
Mailing address
18205 N 51ST AVE, SUITE 113, GLENDALE, AZ 85308-1490
(602) 354-4370
(602) 354-4370
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP3870
AZ
Other
Enumeration date
02/04/2014
Last updated
02/04/2014
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