Healthcare Provider Details

I. General information

NPI: 1962076885
Provider Name (Legal Business Name): DIAPASON PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 E BASELINE RD STE 110
MESA AZ
85206-4674
US

IV. Provider business mailing address

4838 E BASELINE RD STE 110
MESA AZ
85206-4674
US

V. Phone/Fax

Practice location:
  • Phone: 480-426-0767
  • Fax: 480-436-6611
Mailing address:
  • Phone: 480-426-0767
  • Fax: 480-436-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID ALEXANDER WARKENTIN
Title or Position: OWNER
Credential: DC
Phone: 310-770-6368