Provider Demographics
NPI:1598736126
Name:AMBROSIA, ALPHONSE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALPHONSE
Middle Name:
Last Name:AMBROSIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6116 E ARBOR AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6107
Mailing Address - Country:US
Mailing Address - Phone:480-641-5400
Mailing Address - Fax:480-218-4705
Practice Address - Street 1:6116 E ARBOR AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6107
Practice Address - Country:US
Practice Address - Phone:480-641-5400
Practice Address - Fax:480-218-4705
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2705207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease