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General NPI Number Information
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NPI Number | 1255842365
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Entity Type | Organization
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Legal Business Name | PAIN AND SPINE TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 16620 N 40TH ST STE D1
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City | PHOENIX
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State | AZ
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Zip | 85032-3350
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Country | US
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Telephone | 480-565-7346
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Fax |
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Provider Business Mailing Address
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Address Line | 2345 E THOMAS RD STE 400
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City | PHOENIX
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State | AZ
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Zip | 85016-7862
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Country | US
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Telephone | 602-343-2941
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Fax | 623-748-5540
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARTHA HERNANDEZ
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Credential |
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Telephone | 602-343-2907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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