Healthcare Provider Details

I. General information

NPI: 1912232018
Provider Name (Legal Business Name): DAWN CELESTE DENZIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E UNIVERSITY DR STE 200
MESA AZ
85203-8308
US

IV. Provider business mailing address

1901 E UNIVERSITY DR STE 200
MESA AZ
85203-8308
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-3491
  • Fax:
Mailing address:
  • Phone: 480-807-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-01458P
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: