Healthcare Provider Details

I. General information

NPI: 1932283686
Provider Name (Legal Business Name): PWC II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 12TH PL SUITE 1
PRESCOTT AZ
86305-1433
US

IV. Provider business mailing address

919 12TH PL SUITE 1
PRESCOTT AZ
86305-1433
US

V. Phone/Fax

Practice location:
  • Phone: 928-778-4300
  • Fax: 928-771-0920
Mailing address:
  • Phone: 928-778-4300
  • Fax: 928-771-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number28766
License Number StateAZ

VIII. Authorized Official

Name: DR. RICHARD M OHANESIAN
Title or Position: PARTNER
Credential: M.D.
Phone: 928-778-4300