Healthcare Provider Details

I. General information

NPI: 1558718619
Provider Name (Legal Business Name): VINICIUS KNABBEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N WILLIAMSON AVE
WINSLOW AZ
86047-2735
US

IV. Provider business mailing address

9878 W BELLEVIEW AVE # 5114
DENVER CO
80123-2101
US

V. Phone/Fax

Practice location:
  • Phone: 928-289-4691
  • Fax:
Mailing address:
  • Phone: 844-466-6827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number58256
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: