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General NPI Number Information
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NPI Number | 1225436694
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Entity Type | Organization
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Legal Business Name | CAPSTONE MEDICAL ARIZONA, LLC
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 5330 HWY 95
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-9225
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Country | US
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Telephone | 702-289-4137
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52650
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City | MESA
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State | AZ
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Zip | 85208-0133
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Country | US
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Telephone | 702-289-4137
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Fax | 888-945-4264
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. HENRY LIANG
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Credential | D.O.
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Telephone | 702-389-4137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DO1477
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License Number State | NV
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