Organization
KETAMINE AMERICA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID A WARKENTIN DC (CEO/OWNER)
(310) 770-6368
Entity
Organization
Contact information
Practice address
4838 E BASELINE RD STE 110, MESA, AZ 85206-4674
(480) 426-0767
(480) 436-6611
Mailing address
4838 E BASELINE RD STE 110, MESA, AZ 85206-4674
(480) 426-0767
(480) 436-6611
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
208VP0000X
Pain Medicine Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
05/15/2021
Last updated
05/15/2021
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