Healthcare Provider Details

I. General information

NPI: 1649561580
Provider Name (Legal Business Name): NEUROCRITICAL CARE AND STROKE OF ARIZONA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E DUNLAP AVE
PHOENIX AZ
85020-2825
US

IV. Provider business mailing address

111 E DUNLAP AVE STE 1-279
PHOENIX AZ
85020-2807
US

V. Phone/Fax

Practice location:
  • Phone: 602-396-7491
  • Fax:
Mailing address:
  • Phone: 602-396-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTOR ZACH
Title or Position: MANAGER
Credential: MD
Phone: 480-420-6428