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General NPI Number Information
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NPI Number | 1336431907
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Entity Type | Individual
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Provider Name | VITALIY ZHIVOTENKO D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 5410 N SCOTTSDALE RD STE I-100A
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-5927
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Country | US
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Telephone | 480-572-2444
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Fax | 602-581-7158
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Provider Business Mailing Address
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Address Line | 5410 N SCOTTSDALE RD STE I-100A
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-5927
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Country | US
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Telephone | 480-572-2444
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Fax | 602-581-7158
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 282150
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 282150
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 008793
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License Number State | AZ
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