Organization
CASPIAN GLEAM MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FARBOD MISAGHIAN (OWNER)
(801) 884-9687
Entity
Organization
Contact information
Practice address
3130 STILLWATER DRIVE, SUITE B, PRESCOTT, AZ 86305
(801) 884-9687
Mailing address
3270 ROSE LN, PRESCOTT, AZ 86305-3744
(801) 884-9687
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
10/06/2016
Last updated
10/06/2016
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