Healthcare Provider Details

I. General information

NPI: 1851363436
Provider Name (Legal Business Name): MELISSA RUBENZIK ROSENFELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

PO BOX 10459
PHOENIX AZ
85064-0459
US

V. Phone/Fax

Practice location:
  • Phone: 480-515-6296
  • Fax:
Mailing address:
  • Phone: 602-262-8917
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number31621
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: