Individual
CODY VICARIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
4733 W HATCHER RD, GLENDALE, AZ 85302-3625
(951) 751-4576
Mailing address
21538 N 58TH ST, PHOENIX, AZ 85054-5729
(951) 751-4576
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
274765
AZ
163WC0200X
Critical Care Medicine Registered Nurse
274765
AZ
Other
Enumeration date
12/16/2022
Last updated
09/18/2024
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