Healthcare Provider Details

I. General information

NPI: 1912518044
Provider Name (Legal Business Name): NSOBI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 E BROWN RD STE 101
MESA AZ
85205-4960
US

IV. Provider business mailing address

1652 N CHANNING
MESA AZ
85207-3196
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-3554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEX ONOFREI
Title or Position: SOLE MEMEBER
Credential: MD
Phone: 480-807-3554