Basic Information
| Provider Information | |||||||||
| NPI: | 1538640511 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AKDHC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6622 N 91ST AVE STE 220 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853052569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027596883 | ||||||||
| FaxNumber: | 6022243358 | ||||||||
| Practice Location | |||||||||
| Address1: | 7370 N LA CHOLLA BLVD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857412305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5275472468 | ||||||||
| FaxNumber: | 5205472471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2018 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | ESCOBEDO | ||||||||
| AuthorizedOfficialFirstName: | ADONIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6027596883 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.