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NPI Code Detail

MEDICARE: AVANZAR WELLNESS LLC

MEDICARE: AVANZAR WELLNESS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2103T00000XPsychologist

General Provider Information

NPI Number : 1871126797
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVANZAR WELLNESS LLC
Provider Business Mailing Address
First Line : 10096 W FAIRVIEW AVE STE 160
Second Line :
City : BOISE
State : ID
Zip : 83704-5004
Country : US
Telephone Number : 208-908-7882
Fax Number : 208-908-7883
Provider Business Practice Location Address
First Line : 10096 W FAIRVIEW AVE STE 160
Second Line :
City : BOISE
State : ID
Zip : 83704-5004
Country : US
Telephone Number : 208-908-7882
Fax Number : 208-908-7883
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : JOSE CARBAJAL
Credential : MS
Telephone Number : 208-908-7882
Provider Enumeration Date : 02/19/2020
Last Update Date : 06/02/2025

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Directions to “AVANZAR WELLNESS LLC ” Practice Location

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