Healthcare Provider Details

I. General information

NPI: 1679942668
Provider Name (Legal Business Name): NORAZ SURGICAL ASSISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2015
Last Update Date: 09/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PINE DEL DR
FLAGSTAFF AZ
86005-9603
US

IV. Provider business mailing address

50 PINE DEL DR
FLAGSTAFF AZ
86005-9603
US

V. Phone/Fax

Practice location:
  • Phone: 928-699-6786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOEL PACKARD
Title or Position: OWNER
Credential: CSFA
Phone: 928-699-6786