1225422736 NPI number — THE CENTER FOR MUSCULOSKELETAL ULTRASOUND OF ARIZONA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225422736 NPI number — THE CENTER FOR MUSCULOSKELETAL ULTRASOUND OF ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CENTER FOR MUSCULOSKELETAL ULTRASOUND OF ARIZONA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225422736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 S EL CAMINO REAL STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN CLEMENTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92672-4279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-219-1943
Provider Business Mailing Address Fax Number:
949-218-1946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9821 N 95TH ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-4589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-239-5539
Provider Business Practice Location Address Fax Number:
949-218-1946
Provider Enumeration Date:
03/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JABLON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
480-239-3968

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E11 . This is a "DIAGNOSTIC IMAGING" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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