Healthcare Provider Details

I. General information

NPI: 1104865757
Provider Name (Legal Business Name): HOPE DIABETES CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 E BASELINE RD STE 122
MESA AZ
85204-7288
US

IV. Provider business mailing address

PO BOX 838
GILBERT AZ
85299-0838
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-5933
  • Fax: 480-497-5934
Mailing address:
  • Phone: 480-497-5933
  • Fax: 480-497-5934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2409
License Number StateAZ

VIII. Authorized Official

Name: THUY LYNN NGUYEN
Title or Position: DIRECTOR
Credential:
Phone: 602-492-8606