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General NPI Number Information
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NPI Number | 1922584812
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Entity Type | Organization
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Legal Business Name | NORTHERN ARIZONA ALLERGY GROUP LLC
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 3130 STILLWATER DR STE B
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City | PRESCOTT
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State | AZ
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Zip | 86305-7199
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Country | US
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Telephone | 928-244-7540
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Fax | 928-237-5090
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Provider Business Mailing Address
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Address Line | 3130 STILLWATER DR STE B
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City | PRESCOTT
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State | AZ
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Zip | 86305-7199
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Country | US
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Telephone | 928-244-7540
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Fax | 928-237-5090
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Authorized Official
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Title or Position | OWNER
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Name | RAHMAT AFRASIABI
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Credential | MD
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Telephone | 928-224-7540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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