Organization
GRAND CANYON NEUROLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FELICIA ALDERETE (LEGAL OPERATIONS MANAGER)
(210) 598-2801
Entity
Organization
Contact information
Practice address
10025 E DYNAMITE BLVD, SCOTTSDALE, AZ 85262
(602) 338-9745
Mailing address
MSC 334 PO BOX 29201, PHOENIX, AZ 85038-9201
(602) 338-9745
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
Primary
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Enumeration date
03/16/2017
Last updated
05/07/2021
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