Healthcare Provider Details

I. General information

NPI: 1346880838
Provider Name (Legal Business Name): ARIZONA ADVANCED SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 N 3RD ST
PHOENIX AZ
85004-1303
US

IV. Provider business mailing address

2320 N 3RD ST
PHOENIX AZ
85004-1303
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-9900
  • Fax: 602-258-9904
Mailing address:
  • Phone: 602-649-2007
  • Fax: 602-258-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES E CASTILLO
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 602-258-9900