Individual
DANIEL FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3238 S LAKESIDE RIDGE LOOP, TUCSON, AZ 85730-2700
(520) 971-1398
Mailing address
4000 N CENTRAL AVE STE 100, PHOENIX, AZ 85012-3520
(602) 859-7794
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
385H00000X
Respite Care
BH6623
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH6623
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
03/10/2021
Last updated
09/03/2024
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