Healthcare Provider Details

I. General information

NPI: 1184218935
Provider Name (Legal Business Name): SANO SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 E 25TH ST
TULSA OK
74114-2616
US

IV. Provider business mailing address

3219 E CAMELBACK RD STE 249
PHOENIX AZ
85018-2307
US

V. Phone/Fax

Practice location:
  • Phone: 602-777-0101
  • Fax: 844-722-9329
Mailing address:
  • Phone: 602-777-0101
  • Fax: 844-722-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. NIELS DUTCH ROJAS
Title or Position: OWNER
Credential:
Phone: 602-777-0101