Organization
AKOS LIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESERIE TSOSIE (CREDENTIALING SPECIALIST)
(602) 935-6389
Entity
Organization
Contact information
Practice address
4747 E ELLIOT RD, PHOENIX, AZ 85044-1627
(602) 899-4404
Mailing address
PO BOX 41638, PHOENIX, AZ 85080-1638
(602) 935-6389
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/31/2019
Last updated
01/31/2019
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