Healthcare Provider Details

I. General information

NPI: 1508781642
Provider Name (Legal Business Name): AOM INFUSION CENTERS OF ARIZONA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 E BASELINE RD STE 104
GILBERT AZ
85234-2966
US

IV. Provider business mailing address

4915 E BASELINE RD STE 104
GILBERT AZ
85234-2966
US

V. Phone/Fax

Practice location:
  • Phone: 817-361-7699
  • Fax: 817-361-9671
Mailing address:
  • Phone: 817-361-7699
  • Fax: 817-361-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN LEIZMAN
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 817-361-7699