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General NPI Number Information
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NPI Number | 1346383387
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Entity Type | Organization
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Legal Business Name | ARIZONA SURGEON ASSISTANCE
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2000 E SOUTHERN AVE #105
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City | TEMPE
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State | AZ
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Zip | 85282-7510
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Country | US
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Telephone | 480-820-0627
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Fax | 480-820-4840
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Provider Business Mailing Address
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Address Line | 2000 E SOUTHERN AVE #105
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City | TEMPE
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State | AZ
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Zip | 85282-7510
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Country | US
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Telephone | 480-820-0627
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Fax | 480-820-4840
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | HAITHAM HANNA
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Credential | PA-C
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Telephone | 602-616-9982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1922
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License Number State | AZ
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