Healthcare Provider Details

I. General information

NPI: 1275446148
Provider Name (Legal Business Name): EBS ARIZONA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 E IRONWOOD SQUARE DR STE 206
SCOTTSDALE AZ
85258-4584
US

IV. Provider business mailing address

9500 E IRONWOOD SQUARE DR STE 206
SCOTTSDALE AZ
85258-4584
US

V. Phone/Fax

Practice location:
  • Phone: 480-378-3774
  • Fax:
Mailing address:
  • Phone: 480-378-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MELINDA JOHNSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 480-378-3774