Healthcare Provider Details

I. General information

NPI: 1396013389
Provider Name (Legal Business Name): NEW IMAGE PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 E SHEA BLVD STE 105
SCOTTSDALE AZ
85260-6411
US

IV. Provider business mailing address

7425 E SHEA BLVD STE 105
SCOTTSDALE AZ
85260-6411
US

V. Phone/Fax

Practice location:
  • Phone: 480-596-6886
  • Fax: 480-596-8989
Mailing address:
  • Phone: 480-596-6886
  • Fax: 480-596-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: MRS. LAUREN WIENER
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-596-6886