Proudly Arizona LLC

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Legal business name

PROUDLY ARIZONA LLC

Practice address

1717 W Northern Ave Ste 106
Phoenix, AZ 85021-5400

Phone

(323) 378-8797

NPI assigned

Sep 13, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Esra A Khaleel, MS

Title

Owner/Manager

Phone

(323) 378-8797

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663027200000",
    "number": "1184346405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4816 W BETHANY HOME RD APT 90",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853015233",
            "telephone_number": "323-378-8797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 W NORTHERN AVE STE 106",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850215400",
            "telephone_number": "323-378-8797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROUDLY ARIZONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-13",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A",
        "authorized_official_last_name": "KHALEEL",
        "authorized_official_first_name": "ESRA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "323-378-8797",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "342000000X",
            "taxonomy_group": "",
            "desc": "Transportation Network Company",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Non-emergency Medical Transport (VAN) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Non-emergency Medical Transport (VAN) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.