Healthcare Provider Details

I. General information

NPI: 1538670880
Provider Name (Legal Business Name): NOBILIS ARIZONA HOLDING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 E BELL RD STE 143
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

11700 KATY FWY STE 300
HOUSTON TX
77079-1218
US

V. Phone/Fax

Practice location:
  • Phone: 480-619-4097
  • Fax: 480-619-4098
Mailing address:
  • Phone: 713-355-8614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARISSA ARREOLA
Title or Position: CSO
Credential:
Phone: 713-256-9455