Organization
AKOS LIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESERIE TSOSIE (CREDENTIALING SPECIALIST)
(602) 935-6389
Entity
Organization
Contact information
Practice address
4811 N 83RD AVE, PHOENIX, AZ 85033-1000
(602) 899-4404
Mailing address
PO BOX 41638, PHOENIX, AZ 85080-1638
(602) 899-4404
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/20/2018
Last updated
12/20/2018
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