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General NPI Number Information
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NPI Number | 1417433863
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Entity Type | Organization
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Legal Business Name | TYT PLLC
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 3135 E LINCOLN DR STE B
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City | PHOENIX
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State | AZ
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Zip | 85016-2301
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Country | US
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Telephone | 480-418-1626
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Fax |
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Provider Business Mailing Address
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Address Line | 24200 N ALMA SCHOOL RD UNIT 8
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-3001
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Country | US
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Telephone | 480-818-8617
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PAULA S ROSE
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Credential | CRNA
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Telephone | 480-818-8617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 1129382
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License Number State | AZ
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