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General NPI Number Information
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NPI Number | 1649662206
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Entity Type | Organization
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Legal Business Name | ADVANCED SURGERY CENTER OF ARIZONA, LLP
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 10255 N 32ND ST STE A
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City | PHOENIX
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State | AZ
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Zip | 85028-3822
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Country | US
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Telephone | 480-666-9329
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Fax | 480-616-2963
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Provider Business Mailing Address
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Address Line | 10255 N 32ND ST STE A
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City | PHOENIX
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State | AZ
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Zip | 85028-3822
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Country | US
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Telephone | 480-666-9329
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Fax | 480-616-2963
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | AMBER DATTILO
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Credential |
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Telephone | 480-666-9329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery 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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | AZ
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