Organization
EQUALITY MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE MATA-ESPINOZA (CREDENTIALING COORDINATOR)
(602) 687-8219
Entity
Organization
Contact information
Practice address
9020 W THOMAS RD, PHOENIX, AZ 85037-3234
(580) 686-0282
Mailing address
4220 N 20TH AVE, PHOENIX, AZ 85015-5124
(602) 889-9401
(602) 889-9404
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
530088
—
AZ
Enumeration date
05/08/2019
Last updated
09/25/2020
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