Healthcare Provider Details

I. General information

NPI: 1952415358
Provider Name (Legal Business Name): MARINO CAMAIONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 E MISSOURI AVE STE 300
PHOENIX AZ
85012-1351
US

IV. Provider business mailing address

4002 E MAIN STREET SUITE 1
MESA AZ
85205
US

V. Phone/Fax

Practice location:
  • Phone: 602-262-8900
  • Fax: 602-262-8890
Mailing address:
  • Phone: 480-981-9151
  • Fax: 480-324-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number31937
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: