Individual
OMOTOLA GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7808 W THOMAS RD, PHOENIX, AZ 85033-5481
(602) 655-6900
Mailing address
2772 S BAHAMA DR, GILBERT, AZ 85295-6006
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
312202
AZ
Other
Enumeration date
08/01/2024
Last updated
08/01/2024
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