SJ Medical Group

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

AP7650 Issued in AZ

Legal business name

SJ MEDICAL GROUP

Practice address

4622 N 35TH Ave
Phoenix, AZ 85017-3403

Phone

(602) 753-0667

Fax

(602) 441-2202

NPI assigned

Mar 17, 2015

Organization subpart

No

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

Authorized official

Name

Immaculata Inyang, DNP

Title

Provider

Phone

(602) 753-0667

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1426550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426550400000",
    "number": "1669865408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4622 N 35TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850173403",
            "telephone_number": "602-753-0667",
            "fax_number": "602-441-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4622 N 35TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850173403",
            "telephone_number": "602-753-0667",
            "fax_number": "602-441-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SJ MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-17",
        "last_updated": "2015-03-17",
        "status": "A",
        "authorized_official_last_name": "INYANG",
        "authorized_official_first_name": "IMMACULATA",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "602-753-0667",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AZ",
            "license": "AP7650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Primary Care Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; 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.