Organization
RENOVATION SURGICAL ASSISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA KOZIOL (CREDENTIALING)
(480) 376-6456
Entity
Organization
Contact information
Practice address
10290 N 92ND ST STE 200, SCOTTSDALE, AZ 85258-4528
(602) 767-4732
(602) 351-5660
Mailing address
4340 E INDIAN SCHOOL RD # 270, PHOENIX, AZ 85018-5360
(602) 767-4732
(602) 351-5660
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AZ
Enumeration date
12/16/2021
Last updated
12/16/2021
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