Provider Demographics
NPI:1174722458
Name:SANTE PERSONALIZED PREVENTIVE HEALTHCARE, PLLC
Entity type:Organization
Organization Name:SANTE PERSONALIZED PREVENTIVE HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MCBARRON
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-595-3321
Mailing Address - Street 1:2620 N 3RD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1153
Mailing Address - Country:US
Mailing Address - Phone:602-595-3321
Mailing Address - Fax:602-358-8451
Practice Address - Street 1:2620 N 3RD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1153
Practice Address - Country:US
Practice Address - Phone:602-595-3321
Practice Address - Fax:602-358-8451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32892207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty