BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC MESA, AZ

Contact Information

BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC

1450 S DOBSON RD STE B221
MESA, AZ 85202-4745

Phone: 480-827-5370
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Nutrition, Education	133NN1002X
Multi-Specialty	261QM1300X	70	Clinic or Group Practice

Indicates primary specialty

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NPI Profile & details for BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC · (Female)

NPI #	`1790337665`
Status	Active
Credentials
Entity	Individual
Enumeration date	07/11/2019
Last updated	12/28/2021 - About 4 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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