BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
NPI 1790337665
Nutritionist - Nutrition, Education in Mesa, AZ
About Banner Physician Super Specialists Arizona Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC (NPI 1790337665) is a healthcare organization registered as a nutrition, education in Mesa, Arizona and active in the NPI registry since July 2019. The organization holds a CLIA Waiver certificate valid through November 27, 2027 and lists Dennis Laraway, Cfo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Group Practice 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 03D0993904
Banner Physician Super Specialists Arizona LLC · Mesa, AZOther Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Banner Physician Super Specialists Arizona LLC's NPI number?
The NPI number for Banner Physician Super Specialists Arizona LLC is 1790337665. It was assigned to this organization in the NPPES registry on July 11, 2019.
Where is Banner Physician Super Specialists Arizona LLC located?
Banner Physician Super Specialists Arizona LLC is located at 1450 S Dobson Rd Ste B221, Mesa, AZ 85202. The listed phone number is (480) 827-5370.
What is Banner Physician Super Specialists Arizona LLC's specialty?
The primary specialty registered for this NPI is Nutritionist, specializing in Nutrition, Education, with taxonomy code 133NN1002X.
Does Banner Physician Super Specialists Arizona LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 03D0993904) is associated with this NPI, valid through November 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Banner Physician Super Specialists Arizona LLC was last updated on December 28, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Banner Physician Super Specialists Arizona Llc · NPI 1790337665
Nutrition, Education organization in Mesa, Arizona. Organization record, active in the CMS NPPES registry since July 11, 2019.
## Identity
- **NPI:** 1790337665 (Entity type: Organization)
- **Enumerated:** July 11, 2019
- **Primary specialty:** Nutritionist - Nutrition, Education · taxonomy 133NN1002X
- **Organization subpart:** Yes (part of Banner Health)
- **Authorized official:** Dennis Laraway, CFO
## Practice location
- **Address:** 1450 S DOBSON RD STE B221, Mesa, AZ 85202-4745
- **Phone:** (480) 827-5370
## Record status
- **NPPES last updated:** December 28, 2021
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1790337665) · Data from the CMS NPPES public registry.