Healthcare Provider Details

I. General information

NPI: 1649857582
Provider Name (Legal Business Name): PS CLINICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 N 3RD ST STE 300
PHOENIX AZ
85012-2036
US

IV. Provider business mailing address

3724 N 3RD ST STE 301
PHOENIX AZ
85012-2035
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-4222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROGELIO MONZON III
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 602-509-2301