Healthcare Provider Details

I. General information

NPI: 1720549090
Provider Name (Legal Business Name): VIRTUOUS MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E BASELINE RD
TEMPE AZ
85283-1204
US

IV. Provider business mailing address

610 E BASELINE RD
TEMPE AZ
85283-1204
US

V. Phone/Fax

Practice location:
  • Phone: 602-603-0360
  • Fax:
Mailing address:
  • Phone: 602-603-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN NANCE
Title or Position: DIRECTOR
Credential: RN
Phone: 602-903-0360