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General NPI Number Information
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NPI Number | 1639152291
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Entity Type | Individual
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Provider Name | ELISSA B GARTENBERG D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 7522 E 1ST ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-4502
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Country | US
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Telephone | 602-363-1631
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Fax | 888-360-8644
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Provider Business Mailing Address
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Address Line | 16211 N SCOTTSDALE RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1584
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Country | US
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Telephone | 602-363-1631
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Fax | 888-360-8644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101015264
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4155
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License Number State | AZ
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