Provider Demographics
NPI:1356006670
Name:IES OBS ARIZONA PLLC
Entity Type:Organization
Organization Name:IES OBS ARIZONA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZENAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-420-5527
Mailing Address - Street 1:PO BOX 743825
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-3825
Mailing Address - Country:US
Mailing Address - Phone:469-420-5527
Mailing Address - Fax:
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:469-420-5527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty