Healthcare Provider Details

I. General information

NPI: 1285430280
Provider Name (Legal Business Name): ANTHONY MORENO TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 E GELDING DR STE B101
SCOTTSDALE AZ
85260-6948
US

IV. Provider business mailing address

1831 W ROSE GARDEN LN STE 4
PHOENIX AZ
85027-2725
US

V. Phone/Fax

Practice location:
  • Phone: 602-808-9912
  • Fax: 602-875-0385
Mailing address:
  • Phone: 602-808-9912
  • Fax: 602-875-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-047091
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: