Healthcare Provider Details

I. General information

NPI: 1811537194
Provider Name (Legal Business Name): OTA VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 N SCOTTSDALE RD STE 100
SCOTTSDALE AZ
85257-1370
US

IV. Provider business mailing address

4300 N MILLER RD STE 240
SCOTTSDALE AZ
85251-3639
US

V. Phone/Fax

Practice location:
  • Phone: 480-434-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MINOO RAHIMI
Title or Position: CFO
Credential:
Phone: 480-926-7800