Individual
NGOZIKA AMENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15850 N 35TH AVE STE 1, PHOENIX, AZ 85053-3885
(702) 702-2858
Mailing address
15850 N 35TH AVE STE 1, PHOENIX, AZ 85053-3885
(702) 702-2858
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09032019411208
—
AZ
Enumeration date
06/30/2021
Last updated
06/30/2021
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