Healthcare Provider Details

I. General information

NPI: 1952940769
Provider Name (Legal Business Name): GUADALUPE ANESTHESIA GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 W GUADALUPE RD STE 124
GILBERT AZ
85233-3056
US

IV. Provider business mailing address

2250 E GERMANN RD STE 8
CHANDLER AZ
85286-1575
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: RADMAN RAHIMINEJAD
Title or Position: OWNER
Credential:
Phone: 480-926-7800