Organization
KETAMINE WELLNESS CENTERS MESA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANITA D JERGER (EXECUTIVE ASSISTANT)
(855) 538-9355
Entity
Organization
Contact information
Practice address
2451 E BASELINE RD STE 300, GILBERT, AZ 85234-2465
(480) 788-8539
(844) 538-9355
Mailing address
2451 E BASELINE RD STE 300, GILBERT, AZ 85234-2465
(480) 788-8539
(844) 538-9355
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207L00000X
Anesthesiology Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
06/26/2019
Last updated
01/10/2022
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