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General NPI Number Information
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NPI Number | 1386449049
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Entity Type | Organization
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Legal Business Name | NEURON CONNECT LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 4524 N MARYVALE PKWY STE 140
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City | PHOENIX
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State | AZ
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Zip | 85031-1730
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Country | US
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Telephone | 602-888-1012
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Fax | 602-926-8333
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Provider Business Mailing Address
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Address Line | 2303 N 44TH ST STE 14-1428
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City | PHOENIX
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State | AZ
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Zip | 85008-2442
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Country | US
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Telephone | 602-888-1012
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Fax | 602-926-8333
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Authorized Official
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Title or Position | CEO/OWNER
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Name | RYAN BEATTY
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Credential |
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Telephone | 310-877-0127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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