Organization
LAKE PLEASANT SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS MOSHIRI (MANAGER)
(602) 441-3573
Entity
Organization
Contact information
Practice address
15601 N 28TH AVE STE 101, PHOENIX, AZ 85053-4061
(602) 237-6340
Mailing address
10810 N TATUM BLVD STE 102-855, PHOENIX, AZ 85028-6055
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
10/05/2020
Last updated
02/24/2022
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