Healthcare Provider Details

I. General information

NPI: 1902687197
Provider Name (Legal Business Name): SPECTRUM DIALYSIS AZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 N 92ND ST STE 118
SCOTTSDALE AZ
85258-4518
US

IV. Provider business mailing address

18040 SHERMAN WAY STE 210
RESEDA CA
91335-4656
US

V. Phone/Fax

Practice location:
  • Phone: 818-342-3012
  • Fax:
Mailing address:
  • Phone: 818-342-3012
  • Fax: 818-342-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: EYAL SHTORCH
Title or Position: OWNER
Credential: MD
Phone: 818-342-3012