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Organization

ARIZONA OCULOFACIAL PLASTIC ORBIT AND COSMETIC SURGERY, LLC

Active
Other names
Arizona Oculofacial Plastic Orbit and Cosmetic Surgery LLC, Arizona
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID SOTO (CREDENTIALING MANAGER)
(480) 822-6230
Entity
Organization

Contact information

Practice address
1055 S STAPLEY DR, MESA, AZ 85204-5013
(480) 892-8400
(480) 892-1889
Mailing address
PO BOX 40085, MESA, AZ 85274-0085
(323) 533-4452
(480) 994-9479

Taxonomy

Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
247118
AZ
Enumeration date
01/14/2019
Last updated
01/14/2019
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