Organization
PUEBLO RADIOLOGY, LLC
Active
Parent organization
WESTERN ARIZONA RADIOLOGY
Other names
Canyon Medical Imaging
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN ARIZONA RADIOLOGY
Authorized official
MR. DANIEL ALAN DERHAAG (MANAGER)
(602) 973-9800
Entity
Organization
Contact information
Practice address
5501 N 19TH AVE, SUITE 111, PHOENIX, AZ 85015-2450
(602) 973-9800
(602) 973-9933
Mailing address
PO BOX 1810, SCOTTSDALE, AZ 85252-1810
(602) 973-9800
(602) 973-9933
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
863979
—
AZ
Enumeration date
04/12/2010
Last updated
04/12/2010
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