Healthcare Provider Details

I. General information

NPI: 1417003336
Provider Name (Legal Business Name): MOUNTAINVIEW HEAD & NECK SURGEONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38245 N JACQUELINE DR #3
CAVE CREEK AZ
85331-8516
US

IV. Provider business mailing address

38245 N JACQUELINE DR #3
CAVE CREEK AZ
85331-8516
US

V. Phone/Fax

Practice location:
  • Phone: 480-368-9608
  • Fax:
Mailing address:
  • Phone: 480-368-9608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number22016
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number22016
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22016
License Number StateAZ

VIII. Authorized Official

Name: HELEN ELIZABETH WATT
Title or Position: PRACTICE OWNER
Credential:
Phone: 480-368-9608