Healthcare Provider Details

I. General information

NPI: 1609267038
Provider Name (Legal Business Name): ANNUAL WELLNESS CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LAKE HAVASU AVE S STE 103
LAKE HAVASU CITY AZ
86403-0811
US

IV. Provider business mailing address

116 LAKE HAVASU AVE S STE 103
LAKE HAVASU CITY AZ
86403-0811
US

V. Phone/Fax

Practice location:
  • Phone: 928-733-3311
  • Fax:
Mailing address:
  • Phone: 928-733-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD BYRD
Title or Position: OWNER
Credential:
Phone: 928-412-5005