Healthcare Provider Details

I. General information

NPI: 1821447111
Provider Name (Legal Business Name): PAIN AND SPINE CLINICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

16620 N 40TH ST STE D1
PHOENIX AZ
85032-3350
US

V. Phone/Fax

Practice location:
  • Phone: 602-350-0491
  • Fax:
Mailing address:
  • Phone: 480-565-7246
  • Fax: 602-296-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number32182
License Number StateAZ

VIII. Authorized Official

Name: MOHAMMAD ABBASIAN
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 480-565-7246