Healthcare Provider Details

I. General information

NPI: 1821814971
Provider Name (Legal Business Name): SONORAN MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W KATELLA AVE STE 302D
ORANGE CA
92867-4790
US

IV. Provider business mailing address

9192 W UNION HILLS DR
PEORIA AZ
85382-8208
US

V. Phone/Fax

Practice location:
  • Phone: 602-374-4101
  • Fax: 602-441-0522
Mailing address:
  • Phone: 602-374-4101
  • Fax: 602-441-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID NYE
Title or Position: OWNER
Credential: DO
Phone: 480-363-7778