Individual
TOM PLIVATUS ISHENGOMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19535 N 55TH DR, GLENDALE, AZ 85308-6805
(614) 966-0671
Mailing address
3430 BOSTON AVE, OAKLAND, CA 94602-2906
(614) 966-0671
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
11/09/2023
Last updated
11/09/2023
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