Healthcare Provider Details

I. General information

NPI: 1992350672
Provider Name (Legal Business Name): PATH OF WELLNESS HEALING ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 S ALMA SCHOOL RD STE 4
MESA AZ
85210-4004
US

IV. Provider business mailing address

2034 S ALMA SCHOOL RD STE 4
MESA AZ
85210-4004
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-7032
  • Fax:
Mailing address:
  • Phone: 480-712-7032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NICOLE BERRIOS
Title or Position: OWNER/ACUPUNCTURIST
Credential: L.AC.
Phone: 480-712-7032