| Banner Physician Super Specialists Arizona Llc | |
|
1450 S Dobson Rd Ste B221 Mesa AZ 85202-4745 | |
| (480) 827-5370 | |
| Not Available |
| Full Name | Banner Physician Super Specialists Arizona Llc |
|---|---|
| Speciality | Nutritionist - Nutrition, Education |
| Location | 1450 S Dobson Rd Ste B221, Mesa, Arizona |
| Authorized Official Name and Position | Dennis Laraway (CFO) |
| Authorized Official Contact | 6027474000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner Physician Super Specialists Arizona Llc 2901 N Central Ave Ste 160 Phoenix AZ 85012-2702 Ph: () - | Banner Physician Super Specialists Arizona Llc 1450 S Dobson Rd Ste B221 Mesa AZ 85202-4745 Ph: (480) 827-5370 |
| NPI Number | 1790337665 |
|---|---|
| Provider Enumeration Date | 07/11/2019 |
| Last Update Date | 12/28/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790337665 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 133NN1002X | Nutritionist - Nutrition, Education | (* (Not Available)) | Primary |
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