Provider Demographics
NPI:1871314617
Name:AJUESHI, PHILIP RHANIS
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:RHANIS
Last Name:AJUESHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29962 W AVALON DR
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-3179
Mailing Address - Country:US
Mailing Address - Phone:435-703-4465
Mailing Address - Fax:
Practice Address - Street 1:17496 W ELAINE DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1981
Practice Address - Country:US
Practice Address - Phone:917-388-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness