Healthcare Provider Details

I. General information

NPI: 1356771000
Provider Name (Legal Business Name): CASSIDY DOBRATZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2013
Last Update Date: 11/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N GILA SPRINGS BLVD 2102
CHANDLER AZ
85226-2705
US

IV. Provider business mailing address

444 N GILA SPRINGS BLVD 2102
CHANDLER AZ
85226-2705
US

V. Phone/Fax

Practice location:
  • Phone: 480-599-6625
  • Fax:
Mailing address:
  • Phone: 480-599-6625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0899
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: