Provider Demographics
NPI:1588721823
Name:ARIZONA INSTITUTE OF NEUROPSYCIATRIC DISORDERS PC
Entity type:Organization
Organization Name:ARIZONA INSTITUTE OF NEUROPSYCIATRIC DISORDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONDORA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-692-5200
Mailing Address - Street 1:1739 E BEVERLY AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-692-5200
Mailing Address - Fax:928-692-5252
Practice Address - Street 1:1739 E BEVERLY AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3593
Practice Address - Country:US
Practice Address - Phone:928-692-5200
Practice Address - Fax:928-692-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty