Healthcare Provider Details

I. General information

NPI: 1891732129
Provider Name (Legal Business Name): SARA VELAZQUEZ KERTZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 E CACTUS RD #620
SCOTTSDALE AZ
85254-4163
US

IV. Provider business mailing address

4848 E CACTUS RD #620
SCOTTSDALE AZ
85254-4163
US

V. Phone/Fax

Practice location:
  • Phone: 602-996-0190
  • Fax: 602-996-5516
Mailing address:
  • Phone: 602-996-0190
  • Fax: 602-996-5516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3800
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: