=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477910263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZONA SPINE AND PAIN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2016
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 N ESTRELLA PKWY STE 100
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85338-9357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-321-5079
-----------------------------------------------------
Fax | 623-321-5083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6765
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85338-0630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-321-5079
-----------------------------------------------------
Fax | 623-321-5083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHANDRASHEKAR J. KALMAT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 623-321-5079
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 51320
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------