Basic Information
| Provider Information | |||||||||
| NPI: | 1932663531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORTHEN | ||||||||
| FirstName: | SPENCER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5901 W BEHREND DR APT 2139 | ||||||||
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| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853086954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022801219 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5801 S MCCLINTOCK DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852836002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807770900 | ||||||||
| FaxNumber: | 4807771345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2019 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Z00000X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other |
No ID Information.