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Individual

DANIEL ANDERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
12452 N 36TH DR, PHOENIX, AZ 85029-2103
(602) 863-2981
Mailing address
12452 N 36TH DR, PHOENIX, AZ 85029-2103
(602) 863-2981

Taxonomy

Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
10031
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
975667
AHCCCS ID
AZ
Enumeration date
11/29/2006
Last updated
07/08/2007
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