Provider Demographics
NPI:1912589656
Name:COMPASSIONATE SURGICAL CARE, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE SURGICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:VALERIO
Authorized Official - Last Name:CANULLA
Authorized Official - Suffix:X
Authorized Official - Credentials:MD
Authorized Official - Phone:602-571-6521
Mailing Address - Street 1:2990 E NORTHERN AVE STE C103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4839
Mailing Address - Country:US
Mailing Address - Phone:602-772-2382
Mailing Address - Fax:
Practice Address - Street 1:8752 E VIA DE COMMERCIO STE 2
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3396
Practice Address - Country:US
Practice Address - Phone:602-772-2382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty