Healthcare Provider Details

I. General information

NPI: 1790086890
Provider Name (Legal Business Name): RED ROCK PAIN PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16620 N 40TH ST SUITE D1
PHOENIX AZ
85032-3348
US

IV. Provider business mailing address

8970 E RAINTREE DR SUITE 100
SCOTTSDALE AZ
85260-7300
US

V. Phone/Fax

Practice location:
  • Phone: 800-707-3376
  • Fax: 602-388-1347
Mailing address:
  • Phone: 480-609-9300
  • Fax: 480-609-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number41058
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number41058
License Number StateAZ

VIII. Authorized Official

Name: RAMIN DARBANDI-TONKABON
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 314-482-4827