Provider Demographics
NPI:1508309626
Name:VANGUARD MOBILE PHYSICIANS PLLC
Entity Type:Organization
Organization Name:VANGUARD MOBILE PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TARIK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIRIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-246-3593
Mailing Address - Street 1:105 N PASADENA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5013
Mailing Address - Country:US
Mailing Address - Phone:480-246-3500
Mailing Address - Fax:480-246-3525
Practice Address - Street 1:105 N PASADENA ST STE 3
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5013
Practice Address - Country:US
Practice Address - Phone:480-246-3500
Practice Address - Fax:480-246-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty