Healthcare Provider Details

I. General information

NPI: 1679560601
Provider Name (Legal Business Name): CRANIAL TECHNOLOGIES OF MIAMI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 W AUTO DR
TEMPE AZ
85284-1026
US

IV. Provider business mailing address

1395 W AUTO DR
TEMPE AZ
85284-1026
US

V. Phone/Fax

Practice location:
  • Phone: 480-505-1840
  • Fax: 480-505-1844
Mailing address:
  • Phone: 480-505-1840
  • Fax: 480-505-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JEANNE K HERTZ
Title or Position: CHIEF EXECUTIVE OFFICER FOUNDER
Credential: CLINICAL ORTHOTIST
Phone: 480-505-1840