Individual
PATRONG PEOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5102 W CAMPBELL AVE, PHOENIX, AZ 85031-1703
(623) 848-5000
Mailing address
5102 W CAMPBELL AVE, PHOENIX, AZ 85031-1703
(623) 848-5000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5246
AZ
Other
Enumeration date
12/19/2012
Last updated
12/21/2012
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