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General NPI Number Information
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NPI Number | 1861259988
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Entity Type | Organization
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Legal Business Name | PEAK MOBILE WOUND CARE CORP
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 9375 E. SHEA BLVD SUITE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 623-239-9174
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Fax |
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Provider Business Mailing Address
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Address Line | 9375 E. SHEA BLVD SUITE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 623-239-9174
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Fax |
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Authorized Official
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Title or Position | DIR-CONTRACTS/CREDENTIALING
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Name | ADRIAN MIRANDA
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Credential |
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Telephone | 602-570-3169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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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 | 207NP0225X
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Taxonomy Name | Pediatric Dermatology 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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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