Healthcare Provider Details

I. General information

NPI: 1760984215
Provider Name (Legal Business Name): ASCENSION MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9590 E IRONWOOD SQ SUITE 210
SCOTTSDALE AZ
85258
US

IV. Provider business mailing address

4808 N 24TH ST UNIT 805
PHOENIX AZ
85016
US

V. Phone/Fax

Practice location:
  • Phone: 480-668-3485
  • Fax:
Mailing address:
  • Phone: 480-668-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PAYAM SADR
Title or Position: OWNER
Credential:
Phone: 480-668-3485