Healthcare Provider Details

I. General information

NPI: 1346845120
Provider Name (Legal Business Name): SONOSPINE ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 E CAMELBACK RD STE 195
PHOENIX AZ
85018-2657
US

IV. Provider business mailing address

3900 E CAMELBACK RD STE 195
PHOENIX AZ
85018-2657
US

V. Phone/Fax

Practice location:
  • Phone: 888-957-7463
  • Fax:
Mailing address:
  • Phone: 888-957-7463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NICK LLOYD
Title or Position: OWNER
Credential:
Phone: 888-957-7463