Healthcare Provider Details

I. General information

NPI: 1639645138
Provider Name (Legal Business Name): MENDING SPOT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3254 E CACTUS RD
PHOENIX AZ
85032-7233
US

IV. Provider business mailing address

8315 E SAN BERNARDO DR
SCOTTSDALE AZ
85258-2430
US

V. Phone/Fax

Practice location:
  • Phone: 808-457-5807
  • Fax: 480-467-0248
Mailing address:
  • Phone: 808-457-5807
  • Fax: 480-467-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARC RACITI
Title or Position: OWNER
Credential: PA-C
Phone: 808-457-5807