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General NPI Number Information
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NPI Number | 1992036099
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Entity Type | Organization
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Legal Business Name | THE LEIGHTON INSTITUTE FOR AESTHETIC AND RECONSTRUCTIVE PLASTIC SURGER
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 7425 E SHEA BLVD SUITE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6411
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Country | US
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Telephone | 480-948-3250
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Fax | 480-905-6941
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Provider Business Mailing Address
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Address Line | 7425 E SHEA BLVD SUITE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6411
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Country | US
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Telephone | 480-948-3250
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Fax | 480-905-6941
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARY ANN WENTZEL
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Credential |
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Telephone | 480-948-3250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 12814
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License Number State | AZ
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