Organization
SAG, LLC
Active
Other names
Center For Pain Control, Center for Pain control
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE MATA-ESPINOZA (CREDENTIALING COORDINATOR)
(602) 687-8219
Entity
Organization
Contact information
Practice address
3306 W ROOSEVELT ST, PHOENIX, AZ 85009-3404
(602) 889-9401
(602) 269-7772
Mailing address
4220 N 20TH AVE, PHOENIX, AZ 85015-5124
(602) 889-9401
(602) 889-9404
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QP3300X
Pain Clinic/Center
—
AZ
261QP3300X
Pain Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
444776
—
AZ
Enumeration date
02/25/2009
Last updated
07/21/2022
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