Individual
ANGELA WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2126 W CAMERON BLVD, COOLIDGE, AZ 85128-3280
(520) 560-2800
Mailing address
994 S HARRISON RD, TUCSON, AZ 85748-6608
(520) 721-1887
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
9957980
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9957980
THERAPEUTIC FOSTER CARE
AZ
Enumeration date
07/23/2019
Last updated
07/23/2019
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