Caspian Gleam Medical Center LLC
Clinic/Center in Prescott, AZ. Organization (NPI-2).
NPI number1174073837
StatusActive
Last updated in NPPESOct 6, 2016
Details
- NPI
- 1174073837
- Entity type
- Organization (NPI-2)
- Legal business name
- Caspian Gleam Medical Center LLC
- Organization subpart
- No
- Enumeration date
- Oct 6, 2016
- Last updated
- Oct 6, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – |
Practice location
3130 Stillwater Drive, Suite BPrescott, AZ 86305
Phone 801-884-9687
Mailing address
3270 Rose LnPrescott, AZ 86305-3744
Phone 801-884-9687
Authorized official
Farbod Misaghian
Owner
8018849687
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