=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699353870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRAT-O-SPHERE INTERNATIONAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2021
-----------------------------------------------------
Last Update Date | 09/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3617 W EL CAMINO DR
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85051-9119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-875-1637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3617 W EL CAMINO DR
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85051-9119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-875-1637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REVEREND /OWNER
-----------------------------------------------------
Name | DAVID WAYNE HERTZBERG
-----------------------------------------------------
Credential | REIKI MASTER TCM
-----------------------------------------------------
Telephone | 480-875-1637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1710I1003X
-----------------------------------------------------
Taxonomy Name | Independent Duty Medical Technicians
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------