# SOUTHWEST ENDOVASCULAR CENTER, LLC

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

## Provider details

- **NPI number:** 1760021802
- **Authorized official:** NETTIE CASTILLO (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (480) 542-4714

## Contact information

- **Practice address:** 7529 E BROADWAY RD, MESA, AZ 85208
- **Practice address phone:** (480) 945-4343
- **Practice address fax:** (480) 945-4350
- **Mailing address:** 140 S POWER RD STE 102, MESA, AZ 85206-5297
- **Mailing address phone:** (480) 542-4714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/06/2020
- **Last updated:** 01/06/2020