Healthcare Provider Details

I. General information

NPI: 1902648322
Provider Name (Legal Business Name): SPINE AND ORTHOPEDIC SPECIALISTS OF ARIZONA, PLCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 N PERIMETER DR
SCOTTSDALE AZ
85255-7800
US

IV. Provider business mailing address

17500 N PERIMETER DR
SCOTTSDALE AZ
85255-7800
US

V. Phone/Fax

Practice location:
  • Phone: 623-624-4765
  • Fax: 623-624-4766
Mailing address:
  • Phone: 623-624-4765
  • Fax: 623-624-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARIANNE YANTZ
Title or Position: ASST ADMIN
Credential:
Phone: 516-507-0800