MEDICARE: DEER VALLEY SPINE CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	AZ 35194	AZ

General Provider Information

NPI Number	:	1811940554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEER VALLEY SPINE CENTER, LLC

Provider Business Mailing Address
First Line	:	2735 W UNION HILLS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-5033
Country	:	US
Telephone Number	:	602-588-2225
Fax Number	:	602-588-2226

Provider Business Practice Location Address
First Line	:	2735 W UNION HILLS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-5033
Country	:	US
Telephone Number	:	602-588-2225
Fax Number	:	602-588-2226

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JACOB AMRANI II
Credential	:	MD
Telephone Number	:	602-588-2225

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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