Organization
DIABETES AMERICA AZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA JOHNSON (CREDENTIALING COORDINATOR)
(713) 840-5245
Entity
Organization
Contact information
Practice address
2875 W RAY RD, SUITE 16, CHANDLER, AZ 85224-3524
(480) 855-6075
(480) 855-6085
Mailing address
13171 MISTY WILLOW DR, HOUSTON, TX 77070-5635
(832) 237-3500
(832) 237-0200
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407282
—
AZ
Enumeration date
06/23/2008
Last updated
08/08/2011
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