Organization
GLENDALE REDBIRD CO
Active
Parent organization
RADADVANTAGE A PROFESSIONAL CORP.
Other names
RADADVANTAGE A PROFESSIONAL CORP.
Organization subpart
Yes
Provider details
NPI number
Legal business name
RADADVANTAGE A PROFESSIONAL CORP.
Authorized official
MYDUNG PHAN RDN, RN (CEO)
(480) 918-4775
Entity
Organization
Contact information
Practice address
6637 N 58TH DR APT 3, GLENDALE, AZ 85301-3900
(480) 918-4775
Mailing address
6637 N 58TH DR APT 3, GLENDALE, AZ 85301-3900
(480) 918-4775
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167030
—
AZ
Enumeration date
02/18/2025
Last updated
02/18/2025
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