Healthcare Provider Details

I. General information

NPI: 1780943456
Provider Name (Legal Business Name): DESERT ROSE NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 E WILCOX DR
SIERRA VISTA AZ
85635-2841
US

IV. Provider business mailing address

2480 E WILCOX DR
SIERRA VISTA AZ
85635-2841
US

V. Phone/Fax

Practice location:
  • Phone: 520-417-1133
  • Fax: 520-417-1133
Mailing address:
  • Phone: 520-417-1133
  • Fax: 520-417-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number19818
License Number StateAZ

VIII. Authorized Official

Name: DR. GUY C CARY
Title or Position: OWNER
Credential: MD
Phone: 520-417-1133