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General NPI Number Information
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NPI Number | 1356887137
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSISTANTS OF ARIZONA
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 320 BUCCANEER LN
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-6945
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Country | US
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Telephone | 313-778-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 320 BUCCANEER LN
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-6945
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Country | US
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Telephone | 313-778-4144
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Fax |
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Authorized Official
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Title or Position | SURGICAL ASSISTANT
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Name | MICHAEL ISMAIL ISMAIL
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Credential |
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Telephone | 313-778-4144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 3932
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License Number State | MI
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