Healthcare Provider Details

I. General information

NPI: 1437936655
Provider Name (Legal Business Name): SAN TAN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S STAPLEY DR STE 217
MESA AZ
85204-6679
US

IV. Provider business mailing address

1910 S STAPLEY DR STE 217
MESA AZ
85204-6679
US

V. Phone/Fax

Practice location:
  • Phone: 602-888-0370
  • Fax: 480-748-4095
Mailing address:
  • Phone: 602-888-0370
  • Fax: 480-748-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DONALD MASON
Title or Position: OWNER
Credential: DMSC, PA-C
Phone: 602-888-0370