Healthcare Provider Details

I. General information

NPI: 1922584812
Provider Name (Legal Business Name): NORTHERN ARIZONA ALLERGY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 STILLWATER DR STE B
PRESCOTT AZ
86305-7199
US

IV. Provider business mailing address

3130 STILLWATER DR STE B
PRESCOTT AZ
86305-7199
US

V. Phone/Fax

Practice location:
  • Phone: 928-244-7540
  • Fax: 928-237-5090
Mailing address:
  • Phone: 928-244-7540
  • Fax: 928-237-5090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: RAHMAT AFRASIABI
Title or Position: OWNER
Credential: MD
Phone: 928-224-7540