Healthcare Provider Details

I. General information

NPI: 1871853978
Provider Name (Legal Business Name): NASSIM HADDAD MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 N 92ND ST STE 101
SCOTTSDALE AZ
85258-4553
US

IV. Provider business mailing address

10101 N 92ND ST STE 101
SCOTTSDALE AZ
85258-4553
US

V. Phone/Fax

Practice location:
  • Phone: 480-747-6532
  • Fax: 480-889-6865
Mailing address:
  • Phone: 480-747-6532
  • Fax: 480-889-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: NASSIM HADDAD
Title or Position: MEMBER
Credential: MD
Phone: 480-747-6532