BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC NPI 1790337665

NPI Information

NPI: 1790337665
Provider Name: BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
Classification: Nutritionist - 133NN1002X
Entity Type: Organization

Specialization: Nutrition, Education

CLIA Number: 03D0993904

Address:
1450 S DOBSON RD STE B221
MESA, AZ
ZIP 85202
Phone: (480) 827-5370
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BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC is a nutrition and education nutritionist in Mesa, AZ. BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC NPI is 1790337665. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1450 S DOBSON RD STE B221
MESA, AZ
ZIP 85202-745
Phone: (480) 827-5370

The provider's authorized official is Dennis Laraway .
The authorized official title is Cfo and has the following contact phone number (602) 747-4000.

The CLIA number assigned to this NPI record is 03D0993904 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/11/2019 and was last updated on 12/28/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	133NN1002X	Nutritionist	Nutrition, Education			Yes
2	261QM1300X	Clinic/Center	Multi-Specialty			No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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