# KETAMINE AMERICA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053985986
- **Authorized official:** DAVID A WARKENTIN DC (CEO/OWNER)
- **Authorized official phone:** (310) 770-6368

## Contact information

- **Practice address:** 4838 E BASELINE RD STE 110, MESA, AZ 85206-4674
- **Practice address phone:** (480) 426-0767
- **Practice address fax:** (480) 436-6611
- **Mailing address:** 4838 E BASELINE RD STE 110, MESA, AZ 85206-4674
- **Mailing address phone:** (480) 426-0767
- **Mailing address fax:** (480) 436-6611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 2084P0802X | Addiction Psychiatry Physician | — | NULL | — |
| 2084P0802X | Addiction Psychiatry Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 05/15/2021
- **Last updated:** 05/15/2021