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Organization

NEXT GEN MEDICUS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CRYSTAL ALEJO (CREDENTIALING SUPERVISOR)
(480) 703-1883
Entity
Organization

Contact information

Practice address
2075 S COTTONWOOD DR, TEMPE, AZ 85282-3040
(602) 362-1823
Mailing address
2075 S COTTONWOOD DR, TEMPE, AZ 85282-3040
(602) 362-1823

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
103TA0400X
Addiction (Substance Use Disorder) Psychologist
103TP2701X
Group Psychotherapy Psychologist
207R00000X
Internal Medicine Physician
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
261QM1300X
Multi-Specialty Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
44177
AZ LICENSE
AZ
05
595199
AZ
Enumeration date
06/07/2019
Last updated
09/04/2019
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