Provider Demographics
NPI:1639303464
Name:MY DOC LLC
Entity Type:Organization
Organization Name:MY DOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALDEMIR
Authorized Official - Middle Name:T
Authorized Official - Last Name:COELHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-841-7588
Mailing Address - Street 1:5501 N 19TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2451
Mailing Address - Country:US
Mailing Address - Phone:602-841-7588
Mailing Address - Fax:602-249-5080
Practice Address - Street 1:5501 N 19TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2451
Practice Address - Country:US
Practice Address - Phone:602-841-7588
Practice Address - Fax:602-249-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center