Provider Demographics
NPI:1831897933
Name:DR. TRACEY ROSENFELD LLC
Entity type:Organization
Organization Name:DR. TRACEY ROSENFELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:ALAYNE
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-656-1147
Mailing Address - Street 1:2515 N SCOTTSDALE RD STE 14
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1352
Mailing Address - Country:US
Mailing Address - Phone:480-656-1147
Mailing Address - Fax:
Practice Address - Street 1:2515 N SCOTTSDALE RD STE 14
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1352
Practice Address - Country:US
Practice Address - Phone:480-656-1147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty