Healthcare Provider Details

I. General information

NPI: 1245941210
Provider Name (Legal Business Name): SONORA NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 N 3RD ST STE 290
PHOENIX AZ
85012-2071
US

IV. Provider business mailing address

PO BOX 34202
PHOENIX AZ
85067-4202
US

V. Phone/Fax

Practice location:
  • Phone: 602-835-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OBADA SUBEI
Title or Position: OWNER
Credential: MD
Phone: 517-402-0416