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General NPI Number Information
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NPI Number | 1679059984
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Entity Type | Organization
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Legal Business Name | PREMIER REGENERATIVE CENTERS OF ARIZONA, PLLC
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 2629 N SCOTTSDALE RD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85257
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Country | US
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Telephone | 602-510-3203
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Fax | 602-297-6997
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Provider Business Mailing Address
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Address Line | 2629 N SCOTTSDALE RD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-1370
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Country | US
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Telephone | 602-510-3203
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Fax | 602-297-6997
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TINA MANKIN
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Credential | MSN, RN
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Telephone | 602-510-3203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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