Healthcare Provider Details

I. General information

NPI: 1760589899
Provider Name (Legal Business Name): J.C. BERARDI INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 E. BAHIA DRIVE SUITE 110
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

8900 E. BAHIA DRIVE SUITE 110
SCOTTSDALE AZ
85260
US

V. Phone/Fax

Practice location:
  • Phone: 480-502-4567
  • Fax: 480-502-0353
Mailing address:
  • Phone: 480-502-4567
  • Fax: 480-502-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35007
License Number StateAZ

VIII. Authorized Official

Name: DR. JOSEPH CHRISTOPHER BERARDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 480-502-4567