| NPI | 1649598426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KNAYA TABORA Owner/Member Manager 928-788-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine |
| 207T00000X Neurological Surgery (Licence: AZ 20605) | |
| 207T00000X Neurological Surgery (Licence: NY 5573) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: AZ 20605) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: NV 5573) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| 363L00000X Nurse Practitioner (Licence: AZ AP8599) | |
| 363L00000X Nurse Practitioner (Licence: AZ AP3760) | |
| 363LF0000X Nurse Practitioner Family (Licence: AZ AP8599) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: AZ AP8599) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2023-10-12 |