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General NPI Number Information
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NPI Number | 1295050409
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Entity Type | Organization
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Legal Business Name | MOVEMENT DISORDERS CENTER OF ARIZONA LLC
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 13945 W GRAND AVE SUITE 102
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City | SURPRISE
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State | AZ
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Zip | 85374-2437
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Country | US
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Telephone | 480-526-5441
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Fax | 480-526-5443
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Provider Business Mailing Address
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Address Line | 10635 N 140TH WAY
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-5500
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Country | US
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Telephone | 480-526-5449
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Fax | 480-526-5443
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. VIRGILIO GERALD HILARIO EVIDENTE
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Credential | M.D.
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Telephone | 480-526-5449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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