Healthcare Provider Details

I. General information

NPI: 1316533870
Provider Name (Legal Business Name): SAGUARO JOINT AND SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 S ELLSWORTH RD STE 109
MESA AZ
85212-2165
US

IV. Provider business mailing address

2919 S ELLSWORTH RD STE 109
MESA AZ
85212-2165
US

V. Phone/Fax

Practice location:
  • Phone: 480-299-5916
  • Fax:
Mailing address:
  • Phone: 480-299-5916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SCOTT TAYLOR
Title or Position: MEMBER
Credential: DC
Phone: 480-299-5916