Healthcare Provider Details

I. General information

NPI: 1386790582
Provider Name (Legal Business Name): PHILIP M WAZNY NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9180 E DESERT COVE AVE STE 105
SCOTTSDALE AZ
85260-6254
US

IV. Provider business mailing address

9180 E DESERT COVE AVE STE 105
SCOTTSDALE AZ
85260-6254
US

V. Phone/Fax

Practice location:
  • Phone: 480-993-3331
  • Fax: 480-800-3240
Mailing address:
  • Phone: 480-993-3331
  • Fax: 480-800-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number06-914
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: