Individual
MATTHEW ODISHOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2114 S 118TH AVE, AVONDALE, AZ 85323-7643
(623) 792-7930
(623) 777-1683
Mailing address
2114 S 118TH AVE, AVONDALE, AZ 85323-7643
(623) 792-7930
(623) 777-1683
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
AL10626H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
381288
AHCCCS
AZ
Enumeration date
07/09/2018
Last updated
07/09/2018
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