Basic Information
| Provider Information | |||||||||
| NPI: | 1568565836 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARL T. HAYDEN VA MED CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 E INDIAN SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
| FaxNumber: | 6022006289 | ||||||||
| Practice Location | |||||||||
| Address1: | 8024 S 53 AVE | ||||||||
| Address2: | |||||||||
| City: | LAVEEN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022374335 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SEARS | ||||||||
| AuthorizedOfficialFirstName: | MAY | ||||||||
| AuthorizedOfficialMiddleName: | MAHINNAZ | ||||||||
| AuthorizedOfficialTitleorPosition: | FNP-C/PCP | ||||||||
| AuthorizedOfficialTelephone: | 6022775551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | RN109527 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.