Organization
OCOTILLO TREATMENT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAICHA L MALDONADO MANAGER (MANAGER)
(480) 441-7700
Entity
Organization
Contact information
Practice address
3645 S ROME ST STE 204, GILBERT, AZ 85297-7338
(480) 771-4400
Mailing address
3645 S ROME ST STE 204, GILBERT, AZ 85297-7338
(480) 771-4400
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
06/04/2018
Last updated
01/02/2020
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