Healthcare Provider Details

I. General information

NPI: 1558912816
Provider Name (Legal Business Name): SPS IOM PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 N SCOTTSDALE RD STE 100
SCOTTSDALE AZ
85257-1370
US

IV. Provider business mailing address

2250 E GERMANN RD STE 8
CHANDLER AZ
85286-1575
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-7227
  • Fax:
Mailing address:
  • Phone: 480-926-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: RADMAN RAHIMINEJAD
Title or Position: OWNER
Credential:
Phone: 480-926-7800