Provider Demographics
NPI:1053610402
Name:ARIZONA MUA SPECIALISTS, LLC
Entity type:Organization
Organization Name:ARIZONA MUA SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-488-4558
Mailing Address - Street 1:8131 N 13TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3893
Mailing Address - Country:US
Mailing Address - Phone:602-488-4558
Mailing Address - Fax:602-759-1741
Practice Address - Street 1:10255 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3851
Practice Address - Country:US
Practice Address - Phone:602-488-4558
Practice Address - Fax:602-759-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty