| Liberation, Llc | |
|
802 N. 5th Pnoenix AZ 85003-1316 | |
| (602) 708-9014 | |
| (888) 349-1581 |
| Full Name | Liberation, Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 802 N. 5th, Pnoenix, Arizona |
| Authorized Official Name and Position | Adeola Adelayo (CEO) |
| Authorized Official Contact | 6027089014 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Liberation, Llc 802 N 5th Ave Phoenix AZ 85003-1316 Ph: (602) 559-4922 | Liberation, Llc 802 N. 5th Pnoenix AZ 85003-1316 Ph: (602) 708-9014 |
| NPI Number | 1518382274 |
|---|---|
| Provider Enumeration Date | 03/04/2014 |
| Last Update Date | 03/04/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518382274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | OTC5977 (Arizona) | Primary |