Provider Demographics
NPI:1487402905
Name:SONORAN INFUSION CENTERS LLC
Entity type:Organization
Organization Name:SONORAN INFUSION CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-571-6762
Mailing Address - Street 1:5333 N 7TH ST STE B112
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2840
Mailing Address - Country:US
Mailing Address - Phone:480-571-6762
Mailing Address - Fax:480-866-8189
Practice Address - Street 1:5333 N 7TH ST STE B112
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2840
Practice Address - Country:US
Practice Address - Phone:480-571-6762
Practice Address - Fax:480-866-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty