Healthcare Provider Details

I. General information

NPI: 1083416903
Provider Name (Legal Business Name): AAP FAMILY WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2753 E BROADWAY RD STE 101-494
MESA AZ
85204-1579
US

IV. Provider business mailing address

2753 E BROADWAY RD STE 101-494
MESA AZ
85204-1579
US

V. Phone/Fax

Practice location:
  • Phone: 480-799-4961
  • Fax:
Mailing address:
  • Phone: 480-799-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REGINE MIRANDA
Title or Position: MANAGER
Credential:
Phone: 480-799-4961