Healthcare Provider Details

I. General information

NPI: 1790570919
Provider Name (Legal Business Name): IMUA CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 E BASELINE RD STE 109-248
MESA AZ
85209-8310
US

IV. Provider business mailing address

9221 E BASELINE RD STE 109-248
MESA AZ
85209-8310
US

V. Phone/Fax

Practice location:
  • Phone: 727-416-1642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMANTHA KALILIKANE
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 727-416-1642