Healthcare Provider Details

I. General information

NPI: 1154712065
Provider Name (Legal Business Name): ELITE PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD SUITE 140
SCOTTSDALE AZ
85251-5648
US

IV. Provider business mailing address

7425 E SHEA BLVD SUITE 103
SCOTTSDALE AZ
85260-6411
US

V. Phone/Fax

Practice location:
  • Phone: 480-513-2727
  • Fax: 480-513-2729
Mailing address:
  • Phone: 480-291-6895
  • Fax: 480-291-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number49766
License Number StateAZ

VIII. Authorized Official

Name: DR. ROZBEH TORABI
Title or Position: MANAGER
Credential: MD
Phone: 401-837-8851