Provider Demographics
NPI:1477910263
Name:ZONA SPINE AND PAIN, LLC
Entity Type:Organization
Organization Name:ZONA SPINE AND PAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRASHEKAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:KALMAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-321-5079
Mailing Address - Street 1:PO BOX 6765
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-0630
Mailing Address - Country:US
Mailing Address - Phone:623-321-5079
Mailing Address - Fax:623-321-5083
Practice Address - Street 1:750 N ESTRELLA PKWY
Practice Address - Street 2:STE 60
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9272
Practice Address - Country:US
Practice Address - Phone:623-321-5079
Practice Address - Fax:623-321-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7523400001Medicare NSC