Provider Demographics
NPI:1306058961
Name:MESA TEMPE ALLERGY & ASTHMA CLINIC PC
Entity type:Organization
Organization Name:MESA TEMPE ALLERGY & ASTHMA CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LABOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-507-1997
Mailing Address - Street 1:2915 E BASELINE RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2425
Mailing Address - Country:US
Mailing Address - Phone:480-507-1997
Mailing Address - Fax:
Practice Address - Street 1:2915 E BASELINE RD
Practice Address - Street 2:SUITE 121
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2425
Practice Address - Country:US
Practice Address - Phone:480-507-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10075207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ120904OtherPTAN