Healthcare Provider Details

I. General information

NPI: 1336667450
Provider Name (Legal Business Name): VINCERE CANCER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7469 E MONTE CRISTO AVE
SCOTTSDALE AZ
85260-1618
US

IV. Provider business mailing address

PO BOX 207433
DALLAS TX
75320-7429
US

V. Phone/Fax

Practice location:
  • Phone: 480-659-0606
  • Fax: 602-331-5886
Mailing address:
  • Phone: 480-625-0003
  • Fax: 480-842-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: PABLO PRICHARD
Title or Position: SOLE MEMBER
Credential: MD
Phone: 602-331-7811