Organization
SUPERNOVA CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIM MATATOV MD (CEO)
(480) 576-4310
Entity
Organization
Contact information
Practice address
4550 E BELL RD STE 150, PHOENIX, AZ 85032-9382
(480) 576-4310
Mailing address
4550 E BELL RD STE 150, PHOENIX, AZ 85032-9382
(480) 576-4310
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
09/16/2019
Last updated
04/26/2021
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