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General NPI Number Information
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NPI Number | 1861922403
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Entity Type | Organization
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Legal Business Name | AZ TECH RADIOLOGY & OPEN MRI
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 8035 E BROWN RD BLDG 4
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City | MESA
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State | AZ
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Zip | 85207-3902
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Country | US
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Telephone | 480-889-3500
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Fax | 480-889-3501
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Provider Business Mailing Address
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Address Line | 2653 W GUADALUPE RD STE 200
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City | MESA
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State | AZ
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Zip | 85202-7200
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Country | US
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Telephone | 480-889-3500
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Fax | 480-889-3501
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RAKESH K PAWHA
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Credential |
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Telephone | 480-889-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M11054
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License Number State | AZ
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