Healthcare Provider Details

I. General information

NPI: 1528556495
Provider Name (Legal Business Name): STONE MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 E CHANDLER BLVD STE 106
PHOENIX AZ
85048-6272
US

IV. Provider business mailing address

1327 E CHANDLER BLVD STE 106
PHOENIX AZ
85048-6272
US

V. Phone/Fax

Practice location:
  • Phone: 480-501-9475
  • Fax: 480-306-7674
Mailing address:
  • Phone: 480-501-9475
  • Fax: 480-306-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINA TRETTER
Title or Position: CO-OWNER
Credential: ANP
Phone: 480-501-9475