Healthcare Provider Details

I. General information

NPI: 1992299499
Provider Name (Legal Business Name): ARIZONA ADVANCED SURGICAL ASSISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5235 E SOUTHERN AVE STE D106-440
MESA AZ
85206-3626
US

IV. Provider business mailing address

5235 E SOUTHERN AVE STE D106-440
MESA AZ
85206-3626
US

V. Phone/Fax

Practice location:
  • Phone: 480-205-9880
  • Fax:
Mailing address:
  • Phone: 602-826-5090
  • Fax: 480-776-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNA FISHER
Title or Position: MANAGER
Credential:
Phone: 602-826-5090