Organization
SOUTHWEST ENDOVASCULAR CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NETTIE CASTILLO (CREDENTIALING SPECIALIST)
(480) 542-4714
Entity
Organization
Contact information
Practice address
7529 E BROADWAY RD, MESA, AZ 85208
(480) 945-4343
(480) 945-4350
Mailing address
140 S POWER RD STE 102, MESA, AZ 85206-5297
(480) 542-4714
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
01/06/2020
Last updated
01/06/2020
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