Healthcare Provider Details

I. General information

NPI: 1518134873
Provider Name (Legal Business Name): ECCO ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 N 16TH ST
PHOENIX AZ
85016-1706
US

IV. Provider business mailing address

PO BOX 29211
PHOENIX AZ
85038-9211
US

V. Phone/Fax

Practice location:
  • Phone: 602-273-6770
  • Fax: 602-889-0483
Mailing address:
  • Phone: 602-273-6770
  • Fax: 602-889-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number33804
License Number StateAZ

VIII. Authorized Official

Name: SAMAN A. FARNOUSH
Title or Position: OWNER
Credential: M.D.
Phone: 602-273-6770