Healthcare Provider Details

I. General information

NPI: 1467563718
Provider Name (Legal Business Name): SURPRISE HEALTH CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/02/2023
Certification Date: 09/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14973 W BELL RD #100
SURPRISE AZ
85374-3202
US

IV. Provider business mailing address

16435 N SCOTTSDALE RD STE 400
SCOTTSDALE AZ
85254-1745
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-2900
  • Fax: 623-583-1319
Mailing address:
  • Phone: 602-675-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EMILY CASTILLO
Title or Position: REGIONAL MANAGER
Credential:
Phone: 702-480-2550