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5720 W Peoria Ave Glendale AZ 85302-1420 | |
| (602) 790-0070 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 5720 W Peoria Ave, Glendale, Arizona |
| Authorized Official Name and Position | Sam Gill (MANAGER) |
| Authorized Official Contact | 6618036307 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6677 W Thunderbird Rd Ste I164 Glendale AZ 85306-3762 Ph: () - | 5720 W Peoria Ave Glendale AZ 85302-1420 Ph: (602) 790-0070 |
| NPI Number | 1568040723 |
|---|---|
| Provider Enumeration Date | 03/30/2021 |
| Last Update Date | 10/08/2024 |
| Medicare PECOS PAC ID | 4486195542 |
|---|---|
| Medicare Enrollment ID | O20240917003610 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568040723 | NPI | - | NPPES |
| OTC13468 | Other | AZ | ARIZONA DEPARTMENT OF HEALTH SERVICES |
| Provider Name | Satinder S Purewal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528161908 PECOS PAC ID: 6002864691 Enrollment ID: I20050111000246 |
| Provider Name | Chen-pei Hung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649549635 PECOS PAC ID: 8426217399 Enrollment ID: I20120313000207 |
| Provider Name | Rosekamal Mckinney |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1457794885 PECOS PAC ID: 8426343708 Enrollment ID: I20160825001481 |
| Provider Name | Cassandra Beth Diaz De Leon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275036584 PECOS PAC ID: 1850646837 Enrollment ID: I20180614002240 |
| Provider Name | Barbara Kayiira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659074110 PECOS PAC ID: 1850754458 Enrollment ID: I20230830001046 |
| Provider Name | Paris Mandy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205502283 PECOS PAC ID: 0749624773 Enrollment ID: I20240219001127 |
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