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Contact Information

KETAMINE WELLNESS CENTERS ARIZONA LLC
113 W HOOVER AVE STE 101
MESA, AZ85210-5214
 Phone: 855-538-9355
 Fax: 844-538-9355
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
 

Pain Medicine

2084P2900X 86 Physician/Neuropsychiatry
 

Pain Medicine

208VP0000X 72 Physician/Pain Management
Indicates primary specialty

NPI Profile & details for KETAMINE WELLNESS CENTERS ARIZONA LLC · (Female)

NPI # 1477935369
Status Active
Credentials
Entity Individual
Enumeration date 06/26/2015
Last updated 08/21/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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