Healthcare Provider Details

I. General information

NPI: 1043608318
Provider Name (Legal Business Name): SRP FACILITY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 N 2ND ST SUITE 200
PHOENIX AZ
85012-2368
US

IV. Provider business mailing address

3330 N 2ND ST SUITE 200
PHOENIX AZ
85012-2368
US

V. Phone/Fax

Practice location:
  • Phone: 951-699-0303
  • Fax: 951-699-0603
Mailing address:
  • Phone: 951-699-0303
  • Fax: 951-699-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANJAY PATEL
Title or Position: MANAGER AND MEMBER
Credential: MD
Phone: 951-699-0303