Healthcare Provider Details
I. General information
NPI: 1720681802
Provider Name (Legal Business Name): CENTER FOR PAIN SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4910 W RAY RD STE 2
CHANDLER AZ
85226-6221
US
IV. Provider business mailing address
4910 W RAY RD STE 2
CHANDLER AZ
85226-6221
US
V. Phone/Fax
- Phone: 480-855-0557
- Fax:
- Phone: 480-855-0557
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207QA0505X |
| Taxonomy | Adult Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
HEATHER
ROPOS
Title or Position: MANAGER
Credential:
Phone: 480-855-0557