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7303 E Main St Ste 106 Mesa AZ 85207-8325 | |
| (954) 865-9794 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 7303 E Main St Ste 106, Mesa, Arizona |
| Authorized Official Name and Position | Richard Gatonga (OWNER) |
| Authorized Official Contact | 9548659794 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7303 E Main St Ste 106 Mesa AZ 85207-8325 Ph: (954) 865-9794 | 7303 E Main St Ste 106 Mesa AZ 85207-8325 Ph: (954) 865-9794 |
| NPI Number | 1326825217 |
|---|---|
| Provider Enumeration Date | 09/13/2023 |
| Last Update Date | 09/18/2024 |
| Certification Date | 09/18/2024 |
| Medicare PECOS PAC ID | 4688105166 |
|---|---|
| Medicare Enrollment ID | O20241008003276 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326825217 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Amy Stoetzel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144058066 PECOS PAC ID: 4981135464 Enrollment ID: I20241008003596 |
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