Organization
KETAMINE CA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHALLEN WAYCHOFF (COO)
(602) 344-9850
Entity
Organization
Contact information
Practice address
6313 SCHIRRA CT STE 1A, BAKERSFIELD, CA 93313-2174
(602) 790-3744
Mailing address
3724 N 3RD ST STE 201, PHOENIX, AZ 85012-2034
(602) 344-9850
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
11/27/2018
Last updated
01/03/2019
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