Healthcare Provider Details

I. General information

NPI: 1700067014
Provider Name (Legal Business Name): RYAN TSUJIMURA MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 E BELL RD # 257
SCOTTSDALE AZ
85260-1502
US

IV. Provider business mailing address

108 W UNIVERSITY DR
MESA AZ
85201-5818
US

V. Phone/Fax

Practice location:
  • Phone: 480-353-2956
  • Fax: 480-353-2957
Mailing address:
  • Phone: 480-649-3774
  • Fax: 480-649-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number23177
License Number StateAZ

VIII. Authorized Official

Name: RYAN TSUJIMURA
Title or Position: OWNER
Credential: MD
Phone: 480-353-2956