Healthcare Provider Details

I. General information

NPI: 1942418132
Provider Name (Legal Business Name): MAFFI PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 N SCOTTSDALE RD SUITE E-200
PARADISE VALLEY AZ
85253-5927
US

IV. Provider business mailing address

5410 N SCOTTSDALE RD SUITE E-200
PARADISE VALLEY AZ
85253-5927
US

V. Phone/Fax

Practice location:
  • Phone: 480-505-6430
  • Fax: 480-505-6429
Mailing address:
  • Phone: 480-505-6430
  • Fax: 480-505-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number32805
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number32805
License Number StateAZ

VIII. Authorized Official

Name: TERRY R MAFFI
Title or Position: OWNER PHYSICIAN
Credential: M.D.
Phone: 480-505-6430