Healthcare Provider Details

I. General information

NPI: 1871544056
Provider Name (Legal Business Name): BEAT E BISENZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13203 N 103RD AVE SUITE H5
SUN CITY AZ
85351-3028
US

IV. Provider business mailing address

PO BOX 53568
PHOENIX AZ
85072-3568
US

V. Phone/Fax

Practice location:
  • Phone: 623-875-6570
  • Fax: 623-972-0049
Mailing address:
  • Phone: 623-544-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3735
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: