Healthcare Provider Details

I. General information

NPI: 1417534462
Provider Name (Legal Business Name): PANNADO GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1846 E INNOVATION PARK DR STE 100
ORO VALLEY AZ
85755-1963
US

IV. Provider business mailing address

1846 E INNOVATION PARK DR STE 100
ORO VALLEY AZ
85755-1963
US

V. Phone/Fax

Practice location:
  • Phone: 310-590-6888
  • Fax:
Mailing address:
  • Phone: 310-590-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAN SCHULTZ
Title or Position: MANAGER
Credential:
Phone: 310-590-6888