| Enroute Provider Services LLC | |
|
17505 N 79th Ave Ste 313a Glendale AZ 85308-8730 | |
| (623) 225-5875 | |
| Not Available |
| Full Name | Enroute Provider Services LLC |
|---|---|
| Speciality | General Practice |
| Location | 17505 N 79th Ave Ste 313a, Glendale, Arizona |
| Authorized Official Name and Position | Dunedin Hervias (FOUNDER) |
| Authorized Official Contact | 6232255875 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Enroute Provider Services LLC 17505 N 79th Ave Ste 313a Glendale AZ 85308-8730 Ph: (623) 225-5875 | Enroute Provider Services LLC 17505 N 79th Ave Ste 313a Glendale AZ 85308-8730 Ph: (623) 225-5875 |
| NPI Number | 1285485920 |
|---|---|
| Provider Enumeration Date | 04/01/2024 |
| Last Update Date | 06/20/2024 |
| Certification Date | 06/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285485920 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | () | Primary |
| 363L00000X | Nurse Practitioner | () | Secondary |
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