Healthcare Provider Details

I. General information

NPI: 1780658492
Provider Name (Legal Business Name): STEVEN W CARBONNIERE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-4322
  • Fax: 602-239-4271
Mailing address:
  • Phone: 602-239-4322
  • Fax: 602-239-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3258
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3258
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: