Provider Demographics
NPI:1679879647
Name:FINKELSTEIN, MARK DAVID (CRT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:FINKELSTEIN
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 N 16TH ST
Mailing Address - Street 2:SUITE 21
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6437
Mailing Address - Country:US
Mailing Address - Phone:602-274-1581
Mailing Address - Fax:602-266-6542
Practice Address - Street 1:3615 N 16TH ST
Practice Address - Street 2:SUITE 21
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6437
Practice Address - Country:US
Practice Address - Phone:602-274-1581
Practice Address - Fax:602-266-6542
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00199372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ449646OtherAHCCCS