Healthcare Provider Details

I. General information

NPI: 1518836915
Provider Name (Legal Business Name): ABAN WELLNESS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2182 AZ - 95
BULLHEAD CITY AZ
86442
US

IV. Provider business mailing address

2220 COUGAR DR APT 2049
LAUGHLIN NV
89029-1282
US

V. Phone/Fax

Practice location:
  • Phone: 702-509-6667
  • Fax:
Mailing address:
  • Phone: 702-509-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State

VIII. Authorized Official

Name: GUILLERMO ZEGARRA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 702-509-6667