Healthcare Provider Details

I. General information

NPI: 1649662206
Provider Name (Legal Business Name): ADVANCED SURGERY CENTER OF ARIZONA, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10255 N 32ND ST STE A
PHOENIX AZ
85028-3822
US

IV. Provider business mailing address

10255 N 32ND ST STE A
PHOENIX AZ
85028-3822
US

V. Phone/Fax

Practice location:
  • Phone: 480-666-9329
  • Fax: 480-616-2963
Mailing address:
  • Phone: 480-666-9329
  • Fax: 480-616-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER DATTILO
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-666-9329