Healthcare Provider Details

I. General information

NPI: 1639557317
Provider Name (Legal Business Name): RRESCAMILLA SURGICAL ASSISTANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 S HIGLEY RD STE 114-273
GILBERT AZ
85297-5438
US

IV. Provider business mailing address

3317 S HIGLEY RD STE 114-273
GILBERT AZ
85297-5438
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2610
  • Fax:
Mailing address:
  • Phone: 480-545-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number14-590
License Number StateAZ

VIII. Authorized Official

Name: ELIZABETH MEYER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 480-545-2610