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General NPI Number Information
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NPI Number | 1265981443
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Entity Type | Organization
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Legal Business Name | AZ VASCULAR CENTER #1 LLC
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 22505 N 19TH AVE #101
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City | PHOENIX
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State | AZ
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Zip | 85027-2161
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Country | US
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Telephone | 314-973-9571
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Fax |
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Provider Business Mailing Address
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Address Line | 3530 S VAL VISTA DR #106
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City | GILBERT
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State | AZ
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Zip | 85297-7318
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Country | US
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Telephone | 314-973-9571
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | KAREN STRONG
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Credential |
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Telephone | 314-973-9571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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