Healthcare Provider Details

I. General information

NPI: 1124428875
Provider Name (Legal Business Name): ARIZONA CENTRAL SURGICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2014
Last Update Date: 08/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 W CAMELBACK RD SUITE 132
PHOENIX AZ
85037-1355
US

IV. Provider business mailing address

9515 W CAMELBACK RD SUITE 132
PHOENIX AZ
85037-1355
US

V. Phone/Fax

Practice location:
  • Phone: 623-247-4900
  • Fax:
Mailing address:
  • Phone: 623-247-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number005651
License Number StateAZ

VIII. Authorized Official

Name: DR. ANTONINO S CAMMARATA
Title or Position: MEMBER
Credential: DO
Phone: 623-341-1604