Basic Information
| Provider Information | |||||||||
| NPI: | 1790086890 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RED ROCK PAIN PHYSICIANS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8970 E RAINTREE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852607300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806099300 | ||||||||
| FaxNumber: | 4806099350 | ||||||||
| Practice Location | |||||||||
| Address1: | 16620 N 40TH ST | ||||||||
| Address2: | SUITE D1 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850323348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007073376 | ||||||||
| FaxNumber: | 6023881347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2010 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | DARBANDI-TONKABON | ||||||||
| AuthorizedOfficialFirstName: | RAMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3144824827 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 41058 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207L00000X | 41058 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 574710 | 05 | AZ | MEDICAID |