Healthcare Provider Details

I. General information

NPI: 1124479910
Provider Name (Legal Business Name): HONOR FAMILY HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W WHITE MOUNTAIN BLVD SUITE D
LAKESIDE AZ
85929-7014
US

IV. Provider business mailing address

300 W WHITE MOUNTAIN BLVD SUITE D
LAKESIDE AZ
85929-7014
US

V. Phone/Fax

Practice location:
  • Phone: 928-368-4547
  • Fax: 928-368-4527
Mailing address:
  • Phone: 928-368-4547
  • Fax: 928-368-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD02923
License Number StateAZ

VIII. Authorized Official

Name: ARLINDA M CORONADO
Title or Position: MANAGING MEMBER
Credential:
Phone: 928-368-4547