Provider Demographics
NPI:1790086890
Name:RED ROCK PAIN PHYSICIANS LLC
Entity Type:Organization
Organization Name:RED ROCK PAIN PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBANDI-TONKABON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-482-4827
Mailing Address - Street 1:8970 E RAINTREE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7300
Mailing Address - Country:US
Mailing Address - Phone:480-609-9300
Mailing Address - Fax:480-609-9350
Practice Address - Street 1:16620 N 40TH ST
Practice Address - Street 2:SUITE D1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3348
Practice Address - Country:US
Practice Address - Phone:800-707-3376
Practice Address - Fax:602-388-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41058207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ574710Medicaid
AZDS5052Medicare PIN
AZZ143711Medicare PIN