Provider Demographics
NPI:1417200882
Name:TOUFIQ, JWAN
Entity Type:Individual
Prefix:
First Name:JWAN
Middle Name:
Last Name:TOUFIQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 W PEORIA AVE STE C111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4715
Mailing Address - Country:US
Mailing Address - Phone:602-283-7100
Mailing Address - Fax:
Practice Address - Street 1:2320 W PEORIA AVE STE C111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4715
Practice Address - Country:US
Practice Address - Phone:602-283-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2639777385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child