Healthcare Provider Details

I. General information

NPI: 1649615899
Provider Name (Legal Business Name): LAKE HAVASU OB-GYN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 MESQUITE AVE UNIT 100
LAKE HAVASU CITY AZ
86403-6897
US

IV. Provider business mailing address

2130 MESQUITE AVE UNIT 100
LAKE HAVASU CITY AZ
86403-6897
US

V. Phone/Fax

Practice location:
  • Phone: 928-302-5100
  • Fax: 928-302-5103
Mailing address:
  • Phone: 928-302-5100
  • Fax: 928-302-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number37930
License Number StateAZ

VIII. Authorized Official

Name: KEVIN HOOKER
Title or Position: OWNER
Credential: MD
Phone: 928-302-5100