Organization
YAVAPAI COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICKI MASTRIANI (ADMIN SUPERVISOR)
(928) 771-3560
Entity
Organization
Contact information
Practice address
6717 E 2ND ST, SUITE D, PRESCOTT VALLEY, AZ 86314-2659
(928) 771-3560
(928) 771-3542
Mailing address
6717 E 2ND ST, SUITE D, PRESCOTT VALLEY, AZ 86314-2659
(928) 771-3560
(928) 771-3542
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110025
—
AZ
Enumeration date
12/09/2009
Last updated
02/04/2010
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