| Organization Name: | ARIZONA BLEEDING DISORDERS HEALTH AND WELLNESS CENTER |
| NPI Number: | 1982090338 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIRBY HOLLIDAY (CREDENTIALING MANAGER) |
| Mailing Address: | 821 N 5th Ave Phoenix |
| State: | AZ US |
| Postal Code: | 850031315 |
| Phone Number: | 6026807722 |
| Fax Number: | 6026825135 |
| NPI Enumeration Date: | 04/13/2015 |
| NPI Last Update Date: | 07/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OTC6802 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |