Provider Demographics
NPI:1619410750
Name:DA VINCI HEALTH SERVICES
Entity Type:Organization
Organization Name:DA VINCI HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDON
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:BAERG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:480-575-1142
Mailing Address - Street 1:4705 E CAREFREE HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4742
Mailing Address - Country:US
Mailing Address - Phone:480-575-1142
Mailing Address - Fax:480-575-6718
Practice Address - Street 1:4705 E CAREFREE HWY STE 106
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-4742
Practice Address - Country:US
Practice Address - Phone:480-575-1142
Practice Address - Fax:480-575-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL21375136261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service