Individual
TUNMISE ODEBIYI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5202 W PECAN RD, LAVEEN, AZ 85339-2460
(623) 329-7459
Mailing address
9307 S 51ST AVE UNIT 29, LAVEEN, AZ 85339-3903
(623) 329-7459
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
DDH3686
AZ
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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