Provider Demographics
NPI:1902687197
Name:SPECTRUM DIALYSIS AZ INC
Entity Type:Organization
Organization Name:SPECTRUM DIALYSIS AZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTORCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-342-3012
Mailing Address - Street 1:18040 SHERMAN WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4656
Mailing Address - Country:US
Mailing Address - Phone:818-342-3012
Mailing Address - Fax:818-342-3013
Practice Address - Street 1:10250 N 92ND ST STE 118
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4518
Practice Address - Country:US
Practice Address - Phone:818-342-3012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty