Provider Demographics
NPI:1205549276
Name:BOBBY D VETERANS GATEWAY
Entity type:Organization
Organization Name:BOBBY D VETERANS GATEWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-678-0333
Mailing Address - Street 1:38 W DUNLAP AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-3524
Mailing Address - Country:US
Mailing Address - Phone:602-675-0333
Mailing Address - Fax:
Practice Address - Street 1:38 W DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-3524
Practice Address - Country:US
Practice Address - Phone:602-675-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health