Healthcare Provider Details

I. General information

NPI: 1548053150
Provider Name (Legal Business Name): CANYON SURGICAL SPECIALISTS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 W THOMAS RD STE 220
PHOENIX AZ
85037-3382
US

IV. Provider business mailing address

9230 W MONTANA DE ORO DR
PEORIA AZ
85383-2204
US

V. Phone/Fax

Practice location:
  • Phone: 623-232-8787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MARC SOLOMAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 623-232-8787