Organization
KETAMINE INFUSION CENTERS, INC
Active
Other names
Ketamine Infusion Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SONNY DIAZ (DIRECTOR)
(602) 344-9850
Entity
Organization
Contact information
Practice address
3724 N 3RD ST STE 201, PHOENIX, AZ 85012-2034
(480) 331-4222
(480) 404-9649
Mailing address
3724 N 3RD ST STE 201, PHOENIX, AZ 85012-2034
(602) 344-9850
(602) 490-8894
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/03/2017
Last updated
07/30/2021
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