Healthcare Provider Details

I. General information

NPI: 1881049021
Provider Name (Legal Business Name): PRECISION TRIALS AZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 W SILVER SAGE LN
PHOENIX AZ
85085-5740
US

IV. Provider business mailing address

3815 E BELL RD SUITE 4500
PHOENIX AZ
85032-2122
US

V. Phone/Fax

Practice location:
  • Phone: 623-824-5239
  • Fax: 623-847-8838
Mailing address:
  • Phone: 602-931-4507
  • Fax: 602-923-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH ANN GONZALES
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 602-931-4507