Healthcare Provider Details

I. General information

NPI: 1083047518
Provider Name (Legal Business Name): HONORHEALTH AMBULATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 09/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 E MCKELLIPS RD SUITE 110
MESA AZ
85203-2783
US

IV. Provider business mailing address

PO BOX 845635
LOS ANGELES CA
90084-5635
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-7370
  • Fax: 480-649-2832
Mailing address:
  • Phone: 623-434-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN NEIL
Title or Position: CMO
Credential:
Phone: 480-587-5123