Enroute Provider Services LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

ENROUTE PROVIDER SERVICES LLC

Practice address

17505 N 79TH Ave Ste 313a
Glendale, AZ 85308-8730

Phone

(623) 225-5875

NPI assigned

Apr 1, 2024

Last updated

Jun 20, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dunedin Hervias, MBA, MHA, LSSBB

Title

Founder

Phone

(623) 225-5875

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1285485920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17505 N 79TH AVE STE 313A",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088730",
            "telephone_number": "623-225-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17505 N 79TH AVE STE 313A",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088730",
            "telephone_number": "623-225-5875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENROUTE PROVIDER SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "HERVIAS",
        "authorized_official_first_name": "DUNEDIN",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "623-225-5875",
        "authorized_official_credential": "MBA, MHA, LSSBB"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• General Practice Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; 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.