Healthcare Provider Details

I. General information

NPI: 1083304000
Provider Name (Legal Business Name): DRAYGONTECH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 W MOUNTAIN VIEW RD APT D215
PHOENIX AZ
85051-2556
US

IV. Provider business mailing address

3115 W MOUNTAIN VIEW RD APT D215
PHOENIX AZ
85051-2556
US

V. Phone/Fax

Practice location:
  • Phone: 503-779-7530
  • Fax:
Mailing address:
  • Phone: 503-779-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY J MILLER
Title or Position: OWNER
Credential:
Phone: 503-779-7530