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General NPI Number Information
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NPI Number | 1780133926
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Entity Type | Organization
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Legal Business Name | DESERT VASCULAR TECHNOLOGIES
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 8020 E THOMAS RD UNIT 120
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6668
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Country | US
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Telephone | 602-595-5027
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Fax |
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Provider Business Mailing Address
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Address Line | 8020 E THOMAS RD UNIT 120
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6668
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Country | US
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Telephone | 602-595-5027
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MIKE SIEGFRIED
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Credential |
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Telephone | 602-595-5027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | C001070
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License Number State | AZ
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