Healthcare Provider Details

I. General information

NPI: 1992780910
Provider Name (Legal Business Name): GUSTAVO J ARMENDARIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE 300
PHOENIX AZ
85016-4879
US

IV. Provider business mailing address

2222 E HIGHLAND AVE STE 300
PHOENIX AZ
85016-4872
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-6211
  • Fax: 866-846-8709
Mailing address:
  • Phone: 602-277-6211
  • Fax: 866-846-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number17271
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: