Healthcare Provider Details

I. General information

NPI: 1316446636
Provider Name (Legal Business Name): ARIZONA LITHOTRIPSY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 N 92ND ST STE 101
SCOTTSDALE AZ
85258-4506
US

IV. Provider business mailing address

77 E THOMAS RD STE 230
PHOENIX AZ
85012-3100
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-2662
  • Fax: 480-661-9716
Mailing address:
  • Phone: 602-557-0007
  • Fax: 602-557-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: C. GILBERTO BRITO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-557-0007