Healthcare Provider Details

I. General information

NPI: 1659981389
Provider Name (Legal Business Name): NEMRA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 N ALMA SCHOOL RD STE 124
CHANDLER AZ
85224-2491
US

IV. Provider business mailing address

1319 E TREASURE COVE DR
GILBERT AZ
85234-2672
US

V. Phone/Fax

Practice location:
  • Phone: 480-755-2277
  • Fax: 480-855-0815
Mailing address:
  • Phone: 818-425-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ARMEN DERIAN
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 480-755-2277