Healthcare Provider Details

I. General information

NPI: 1811940554
Provider Name (Legal Business Name): DEER VALLEY SPINE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 W UNION HILLS DR
PHOENIX AZ
85027-5033
US

IV. Provider business mailing address

2735 W UNION HILLS DR
PHOENIX AZ
85027-5033
US

V. Phone/Fax

Practice location:
  • Phone: 602-588-2225
  • Fax: 602-588-2226
Mailing address:
  • Phone: 602-588-2225
  • Fax: 602-588-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAZ 35194
License Number StateAZ

VIII. Authorized Official

Name: JACOB AMRANI II
Title or Position: PRESIDENT
Credential: MD
Phone: 602-588-2225