NPI 1083742449

Matilda Family Medicine

Organisation Health Maintenance Organization Glendale, AZ

Practice location

Address: 5832 W San Miguel Ave STE 6, Glendale, AZ 85301-5907
Phone: (623) 435-3513
Mailing address: PO Box 232, Litchfield Park, AZ 85340-0232

Authorised official

Name: Valentine Okon
Title: Ceo
Phone: (623) 435-3513

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence PA2363 (AZ)

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Registry record

NPI: 1083742449
Entity type: Organization
NPI issued: 28 Feb 2007
Record last updated: 11 Jul 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.