Healthcare Provider Details

I. General information

NPI: 1396130357
Provider Name (Legal Business Name): CENTER FOR SYSTEMIC HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9817 N 95TH ST BLDG I, SUITE 105
SCOTTSDALE AZ
85258-4587
US

IV. Provider business mailing address

9817 N 95TH ST BLDG I, SUITE 105
SCOTTSDALE AZ
85258-4587
US

V. Phone/Fax

Practice location:
  • Phone: 602-765-2229
  • Fax: 602-493-6641
Mailing address:
  • Phone: 602-765-2229
  • Fax: 602-493-6641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number20957
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN L COUVARAS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 602-765-2229