Healthcare Provider Details

I. General information

NPI: 1255528683
Provider Name (Legal Business Name): DEER VALLEY SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 W UNION HILLS DR SUITE 101
PHOENIX AZ
85027-5033
US

IV. Provider business mailing address

2735 W UNION HILLS DR SUITE 101
PHOENIX AZ
85027-5033
US

V. Phone/Fax

Practice location:
  • Phone: 602-588-2225
  • Fax: 602-588-2226
Mailing address:
  • Phone: 602-588-2225
  • Fax: 602-588-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number35194
License Number StateAZ

VIII. Authorized Official

Name: JACOB AMRANI
Title or Position: OWNER
Credential: M.D
Phone: 602-588-2225