Individual
DERRICK DEVON FARGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16221 N 7TH DR, PHOENIX, AZ 85023-7900
(623) 312-6491
Mailing address
16221 N 7TH DR, PHOENIX, AZ 85023-7900
(480) 709-2868
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
D09261199
AZ
175T00000X
Peer Specialist
Primary
—
AZ
343900000X
Non-emergency Medical Transport (VAN)
D09261199
AZ
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
AZ
Other
Enumeration date
02/26/2026
Last updated
03/23/2026
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