Individual provider Active NPI

Jwan Toufiq

  • Child Mental Illness Respite Care
  • Phoenix, AZ
National Provider Identifier
1417200882
Registry record updated Oct 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child Mental Illness Respite CareTaxonomy code 385HR2055X
License
2639777 Issued in AZ
Practice address
2320 W Peoria Ave Ste C111
Phoenix, AZ 85029-4715
Phone
(602) 283-7100
NPI assigned
Oct 22, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child Mental Illness Respite Care 385HR2055X 2639777 AZ Primary

Addresses

Primary practice location

2320 W Peoria Ave Ste C111
Phoenix, AZ 85029-4715

Mailing address

2320 W Peoria Ave Ste C111
Phoenix, AZ 85029-4715
Phone (602) 283-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2639777AZMDChild Mental Illness Respite Care

NPI Registry JSON

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

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350864000000",
    "number": "1417200882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 W PEORIA AVE STE C111",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294715",
            "telephone_number": "602-283-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 W PEORIA AVE STE C111",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294715",
            "telephone_number": "602-283-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOUFIQ",
        "first_name": "JWAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-22",
        "last_updated": "2012-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": "AZ",
            "license": "2639777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; 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.