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General NPI Number Information
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NPI Number | 1467812552
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC SURGICAL CONCIERGE LLC
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 2222 E HIGHLAND AVE STE 425
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City | PHOENIX
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State | AZ
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Zip | 85016-4872
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Country | US
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Telephone | 480-865-2145
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Fax |
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Provider Business Mailing Address
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Address Line | 2711 CENTERVILLE RD STE 300, PMB #573
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City | WILMINGTON
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State | DE
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Zip | 19808-1660
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Country | US
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Telephone | 480-865-2145
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Fax |
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Authorized Official
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Title or Position | MANAGER/PRESIDENT
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Name | DR. ANGELO MATTALINO
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Credential | M.D.
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Telephone | 480-865-2145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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