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General NPI Number Information
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NPI Number | 1144032905
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Entity Type | Organization
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Legal Business Name | SYNERGY PAIN AND SPINE LLC
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 1001 E WARNER RD STE 103
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City | TEMPE
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State | AZ
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Zip | 85284-3224
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Country | US
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Telephone | 480-570-1536
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Fax |
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Provider Business Mailing Address
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Address Line | 5407 S 18TH PL
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City | PHOENIX
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State | AZ
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Zip | 85040-3363
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Country | US
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Telephone | 480-570-1536
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MOSTAFA MONZER MAITA
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Credential | DO
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Telephone | 602-853-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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