Provider Demographics
NPI:1689951212
Name:R & D CAMELBACK, LLC
Entity type:Organization
Organization Name:R & D CAMELBACK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAAVEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-954-0405
Mailing Address - Street 1:PO BOX 97429
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-7429
Mailing Address - Country:US
Mailing Address - Phone:602-954-0405
Mailing Address - Fax:602-954-0485
Practice Address - Street 1:4901 N 44TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2782
Practice Address - Country:US
Practice Address - Phone:602-954-0405
Practice Address - Fax:602-954-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ656074Medicaid
AZZ150948Medicare PIN