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General NPI Number Information
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NPI Number | 1902403736
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Entity Type | Organization
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Legal Business Name | LAKE PLEASANT SURGICAL CENTER LLC
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 15601 N 28TH AVE STE 101
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City | PHOENIX
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State | AZ
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Zip | 85053-4061
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Country | US
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Telephone | 602-237-6340
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Fax |
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Provider Business Mailing Address
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Address Line | 10810 N TATUM BLVD STE 102-855
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City | PHOENIX
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State | AZ
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Zip | 85028-6055
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | THOMAS MOSHIRI
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Credential |
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Telephone | 602-441-3573
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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 |
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