Basic Information
Provider Information
NPI: 1588077838
EntityType: 2
ReplacementNPI:  
OrganizationName: THE PAIN CENTER OF ARIZONA, PC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ARCADIA
OtherOrganizationType: 5
OtherLastName:  
OtherFirstName:  
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Mailing Information
Address1: 5281 N 99TH AVE
Address2: SUITE 100
City: GLENDALE
State: AZ
PostalCode: 853053105
CountryCode: US
TelephoneNumber: 6235168252
FaxNumber: 6235168253
Practice Location
Address1: 3900 E CAMELBACK RD
Address2: SUITE 190
City: PHOENIX
State: AZ
PostalCode: 850182614
CountryCode: US
TelephoneNumber: 6235168252
FaxNumber: 6232416041
Other Information
ProviderEnumerationDate: 06/04/2014
LastUpdateDate: 07/16/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GRIJALVA
AuthorizedOfficialFirstName: CLAUDIA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CREDENTIALING
AuthorizedOfficialTelephone: 6232416152
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: THE PAIN CENTER OF ARIZONA, PC
AuthorizedOfficialNamePrefix:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208VP0014X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine

No ID Information.


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