Healthcare Provider Details

I. General information

NPI: 1538071303
Provider Name (Legal Business Name): TRISTEN PAHL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24871 S ELLSWORTH RD STE 100-151
QUEEN CREEK AZ
85142-1574
US

IV. Provider business mailing address

2505 E WILLIAMS FIELD RD APT 2080
GILBERT AZ
85295-0825
US

V. Phone/Fax

Practice location:
  • Phone: 480-999-7779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: